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Bourke M, Patterson L, Di Nardo F, Whittaker P, Verma A. Active video games and weight management in overweight children and adolescents-systematic review and meta-analysis. J Public Health (Oxf) 2023; 45:935-946. [PMID: 37496202 PMCID: PMC10788842 DOI: 10.1093/pubmed/fdad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/24/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The prevalence of childhood obesity has been increasing for several decades. Active video games (AVG) may be an effective intervention to help manage this rising health crisis. The aim of this review is to evaluate whether AVG are effective at reducing weight or improving body composition in overweight youths. METHOD Medline, Embase, SportDiscus, ASSIA, CINAHL Plus, CENTRAL, CDSR and PsychINFO databases were searched for studies assessing quantitative or qualitative impact of AVG in overweight adolescents published in English. Three authors screened the results using inclusion/exclusion criteria. RESULTS A total of 12 studies met the inclusion criteria; 11 reported a significant decrease in at least one weight outcome. Results from seven randomized controlled trials were pooled by meta-analysis, which compared with controls subjects in AVG groups demonstrated greater body mass index (BMI) Z-score reduction (mean difference: -0.09 (-0.12, -0.05) I2 = 34%, P < 0.0001). The mean weight reduction (-2.66 Kg (-5.67, +0.35) I2 = 0%, P = 0.08) and BMI (-2.29 (-4.81, +0.22) I2 = 49%, P = 0.07) were greater in AVG groups but results did not reach statistical significance. CONCLUSIONS BMI Z-score was significantly reduced in the AVG group and the majority of included studies reported significant results in at least one weight outcome, suggesting AVG can be used to reduce weight or improve body composition in overweight youths. Further studies investigating the long-term sustainability of this change in body composition are needed.
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Affiliation(s)
- M Bourke
- Institute of Population Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PT, UK
| | - L Patterson
- Institute of Population Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PT, UK
| | - F Di Nardo
- Institute of Population Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PT, UK
- Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Whittaker
- Institute of Population Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PT, UK
| | - A Verma
- Institute of Population Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PT, UK
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Bourke M, Williams N, Dowdall J, Barry MC. Establishment of a clinical nurse specialist-led, virtual aneurysm surveillance clinic. Vascular 2023; 31:749-757. [PMID: 35337231 DOI: 10.1177/17085381221080001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic has necessitated significant changes to the manner in which healthcare is delivered. Chief among these has been the need to rapidly adopt virtual, or telephone clinics as a means of reducing unnecessary patient exposure to hospitals and clinical care settings. We were greatly aided in our adoption of virtual clinics by our experience in the establishment and maintenance of a Clinical Nurse Specialist-led, virtual clinic for both abdominal aortic (AAA) and extra-aortic aneurysm (EAA) surveillance within our department since 2016. Patients undergoing surveillance for abdominal aortic aneurysm (AAA) require frequent and lifelong clinical review. Previous studies have shown that post-operative surveillance in particular is critical in prolonging survival in AAA patients and in the early detection of late complications particularly following endovascular repair (EVAR). Poor compliance with EVAR surveillance has been shown to result in worse outcomes. AIM The aim of this study was to evaluate the success of a nurse-led virtual clinic programme in terms of the safe management of patients undergoing AAA surveillance in a nurse-led virtual clinic. RESULTS Over the course of the 4-year period from 2016 to 2019, 1352 patients were enrolled in the virtual aneurysm surveillance clinic. The majority of patients each year were male, ranging from 78.2% in 2016 to 85.2% in 2017. The majority of patients encountered the service owing to pre-operative surveillance of an AAA, with this group comprising at least 65% of the total cohort of patients each year.Over the course of the 4-year period of the virtual clinic there were 1466 patient encounters. Each ambulatory day care centre (ADCC) attendance normally costs the hospital €149. Therefore, a total saving of €218,434 resulted from this initiative alone. No patient presented as an emergency with a ruptured aneurysm during the time period studied. CONCLUSION Patients with AAA can be safely kept under surveillance in a nurse-led virtual clinic. Our experience with this model of care proved to be particularly advantageous during the period of the early COVID-19 pandemic.
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Affiliation(s)
- M Bourke
- Department of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - N Williams
- Department of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - J Dowdall
- Department of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - M C Barry
- Department of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
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Sopena-Falco J, McCormick A, MacNicholas R, Houlihan D, Bourke M, Feeney E. Hepatitis B related hepatocellular carcinoma. Screening, screening and more screening. Ir Med J 2023; 116:756. [PMID: 37555545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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Shahidi NC, Vosko S, Gupta S, Whitfield A, Cronin O, O’Sullivan T, van Hattem W, Sidhu M, Tate D, Lee E, Burgess N, Williams S, Bourke M. A111 A RECTUM-SPECIFIC SELECTIVE RESECTION ALGORITHM OPTIMIZES ONCOLOGIC OUTCOMES FOR LARGE NON-PEDUNCULATED RECTAL POLYPS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859147 DOI: 10.1093/jcag/gwab049.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are complementary techniques for large (≥ 20mm) non-pedunculated rectal polyps (LNPRPs). A mechanism for appropriate technique selection has not been described. Aims To evaluate whether a selective resection algorithm using EMR and ESD, based on real-time optical evaluation, optimizes oncologic outcomes for LNPRPs Methods We evaluated the performance of a selective resection algorithm (SRA; 08/2017-04/2021) compared to a universal EMR algorithm (UEA; 07/2008-07/2017) for LNPRPs within a prospective observational study. In the SRA, LNPRPs with features of superficial submucosal invasive cancer (SMIC < 1000μm; S-SMIC; Kudo pit pattern Vi), or with an increased risk of SMIC (Paris 0-Is or 0-IIa+Is non-granular, 0-IIa+Is granular with a dominant nodule ≥ 10mm) underwent ESD. The remaining LNPRPs underwent EMR. Algorithm performance was evaluated by SMIC identified after EMR, curative oncologic resection (R0 resection, S-SMIC, absence of negative histologic features), technical success, adverse events, and recurrence at first surveillance colonoscopy. Results 480 LNPRPs were evaluated (290 UEA, 190 SRA). Median lesion size was 40mm (IQR 30-60mm). In the SRA, 103 (54.2%) and 87 (45.8%) LNPRPs underwent EMR and ESD, respectively. SMIC was identified in 56 (11.7%) LNPRPs. Significant differences in SMIC after EMR (SRA 1 (1.0%) vs. UEA 35 (12.1%); p = 0.001), curative oncologic resection (SRA 7 (33.3%) vs. UEA 2 (5.7%); p = 0.010), and recurrence (SRA 2 (1.6%) vs. UEA 40 (17.2%); p < 0.001) were identified. No significant differences in technical success or adverse events were identified (all p > 0.137). Among potentially curable malignant LNPRPs which underwent ESD, 100% (7/7) were cured. Conclusions A SRA optimizes oncologic outcomes for LNPRPs and mitigates the risk of piecemeal resection of cancers. Funding Agencies The Cancer Institute of New South Wales provided funding for a research nurse and data manager to assist with the administration of the study. Neal Shahidi was supported by the University of British Columbia Clinician Investigator Program. There was no influence from either institution regarding study design or conduct, data collection, management, analysis, interpretation, preparation, review, or approval of the manuscript.
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Affiliation(s)
- N C Shahidi
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - S Vosko
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - S Gupta
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - A Whitfield
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - O Cronin
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - T O’Sullivan
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - W van Hattem
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - M Sidhu
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - D Tate
- University Hospital of Ghent, Ghent, Belgium
| | - E Lee
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - N Burgess
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - S Williams
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - M Bourke
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
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Nelson M, Bourke M, Crossley K, Russell T. Telerehabilitation is non-inferior to usual care following total hip replacement - a randomized controlled non-inferiority trial. Physiotherapy 2019; 107:19-27. [PMID: 32026820 DOI: 10.1016/j.physio.2019.06.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/12/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Determine if outpatient physiotherapy care via telerehabilitation is as effective as in-person physiotherapy care after total hip replacement. DESIGN Randomised, single-blind, controlled, non-inferiority clinical trial. SETTING QEII Jubilee Hospital, Brisbane, Australia. PARTICIPANTS Seventy patients receiving a total hip replacement entered the study, sixty-nine completed the study. INTERVENTIONS The control group (n=35; x¯ age 67; female 60%) received in-person outpatient physiotherapy and a paper-based home exercise programme. The intervention group (n=35; x¯ age 62; female 66%) received remotely delivered telerehabilitation directly into their homes and a technology-based home exercise program using an iPad application. MAIN OUTCOME MEASURES The primary outcome was the quality of life subscale of the Hip disability and Osteoarthritis Outcome Score measured at six weeks post-operatively. Secondary outcomes included objective strength and balance outcomes, self-reported function and satisfaction outcomes, and home exercise program compliance. RESULTS No between group difference was detected in the Hip disability and Osteoarthritis Outcome Score quality of life subscale at the primary end point of six weeks (P=0.970). Strength, balance and self-reported function showed no between group differences. Overall satisfaction was high across both groups, with the intervention group scoring higher for ease of attending appointments (intervention 95 (10), control 86 (18), mean difference 9 (95% CI 2 to 16), P=0.017. The intervention group were more compliant with their home exercise programme (intervention 86% (20%), control 74% (26%), mean difference 12% (95% CI 1% to 23%), P=0.048). CONCLUSIONS Telerehabilitation programmes can be delivered to total hip replacement patients in their own homes, using readily available technology while maintaining high levels of satisfaction. More importantly, telerehabilitation patients appear to achieve non-inferior physical and functional outcomes as those receiving in-person rehabilitation programmes. TRIAL REGISTRATION ACTRN12615000824561. (Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- M Nelson
- QEII Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Australia.
| | - M Bourke
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
| | - K Crossley
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, Melbourne, Australia.
| | - T Russell
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
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Golledge J, Morris D, Pinchbeck J, Rowbotham S, Jenkins J, Bourke M, Bourke B, Norman P, Jones R, Moxon J. Metformin Prescription is Associated with a Reduction in the Combined Incidence of Surgical Repair and Rupture Related Mortality in Patients with Abdominal Aortic Aneurysm. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Campana L, Quaglino P, Bechara F, Marconato R, Ascierto P, Caracò C, Brizio M, Clover J, Bourke M, Valpione S, Sersa G, Kunte C, Mühlstädt M, Gerlini G, Hafner J, Patuzzo R, Farronato S, Orlando A, Eisendle K, Kis E. Electrochemotherapy in melanoma: a European e-Delphi survey to define a consensus on indications, treatment modalities and quality indicators. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Brennan J, Bourke M, O’Donnchadha R, Mulrooney A. What Really Matters to You? A Study of Public Perspectives on General Practice in Ireland. Ir Med J 2019; 112:854. [PMID: 30719895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aims In recent years it has been recognised that person-centred care can lead to better outcomes for patients and a reduced burden on healthcare systems. The aim of this study was to explore what really matters to members of the public when they visit a GP in Ireland. Methods This qualitative study used a structured interview methodology with one question; “What really matters to you when you go to see a GP?” Results were analysed using an integrated approach, involving both inductive and deductive methods. Results Responses from the 10 study participants were subdivided into two overarching themes: the General Practitioner as a person and the General Practice as a service. Personality (open, approachable, personable, trusted, interested) and service (time, cost, convenience, personal relationship) traits matter to patients. Conclusion Patients must be facilitated and encouraged to voice what really matters to them in order to inform truly person-centred healthcare improvement.
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Affiliation(s)
- J Brennan
- HSE Dublin/Mid-Leinster General Practice Training Programme
- Royal College of Physicians of Ireland
| | - M Bourke
- Royal College of Surgeons/Dublin North-East General Practice Training Programme
| | - R O’Donnchadha
- HSE Dublin/Mid-Leinster General Practice Training Programme
| | - A Mulrooney
- HSE Dublin/Mid-Leinster General Practice Training Programme
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9
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Golledge J, Moxon J, Pinchbeck J, Anderson G, Rowbotham S, Jenkins J, Bourke M, Bourke B, Dear A, Buckenham T, Jones R, Norman PE. Association between metformin prescription and growth rates of abdominal aortic aneurysms. Br J Surg 2017. [DOI: 10.1002/bjs.10587] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Abstract
Background
It has been suggested that diabetes medications, such as metformin, may have effects that inhibit abdominal aortic aneurysm (AAA) growth. The aim of this study was to examine the association of diabetes treatments with AAA growth in three patient cohorts.
Methods
AAA growth was studied using ultrasound surveillance in cohort 1, repeated CT in cohort 2 and more detailed repeat CT in cohort 3. Growth was estimated by the mean annual increase in maximum AAA diameter.
Results
A total of 1697 patients with an AAA were studied, of whom 118, 39 and 16 patients were prescribed metformin for the treatment of diabetes in cohorts 1, 2 and 3 respectively. Prescription of metformin was associated with a reduced likelihood of median or greater AAA growth in all three cohorts (cohort 1: adjusted odds ratio (OR) 0·59, 95 per cent c.i. 0·39 to 0·87, P = 0·008; cohort 2: adjusted OR 0·38, 0·18 to 0·80, P = 0·011; cohort 3: adjusted OR 0·13, 0·03 to 0·61, P = 0·010). No other diabetes treatment was significantly associated with AAA growth in any cohort.
Conclusion
These findings suggest a potential role for metformin in limiting AAA growth.
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Affiliation(s)
- J Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Queensland, Australia
| | - J Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - J Pinchbeck
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - G Anderson
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - S Rowbotham
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - J Jenkins
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - M Bourke
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Gosford Vascular Clinic, Gosford, New South Wales, Australia
| | - B Bourke
- Gosford Vascular Clinic, Gosford, New South Wales, Australia
| | - A Dear
- Eastern Health Clinical School, Monash University and Department of Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - T Buckenham
- Christchurch School of Medicine and Health Sciences, Otago University, Christchurch, New Zealand
| | - R Jones
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - P E Norman
- School of Surgery, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
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Bourke M, Soden D, Clover AJP. Erratum to: Effective treatment of intractable cutaneous metastases of breast cancer with electrochemotherapy: a useful contributor to cutaneous disease control. Breast Cancer Res Treat 2017; 164:251. [DOI: 10.1007/s10549-017-4307-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bourke M, Fitzgerald T, Donlon N, Flynn S, Creedon S, Sparrow P, Brady A, McEneaney P, O'Brien G, McGreal G. Complications Arising Following Endovascular Repair of Aorto-iliac Aneurysms that Require Open Management: Ten Years’ Experience at a Single Centre. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Russo J, James T, Ruel M, Dupuis J, Singh K, Goubran D, Malhotra N, Chan V, Chong A, Hibbert B, Tanguay J, Lordkipanidzé M, Perrault L, Wells G, Bourke M, Rubens F, So D. ISCHEMIC AND BLEEDING OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING AMONG PATIENTS INITIALLY TREATED WITH A P2Y12 RECEPTOR ANTAGONIST FOR ACUTE CORONARY SYNDROMES - INSIGHTS ON THE USE OF TICAGRELOR VERSUS CLOPIDOGREL PRIOR TO SURGERY. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Russo J, James T, Ruel M, Dupuis J, Singh K, Goubran D, Malhotra N, Chan V, Chong A, Hibbert B, Tanguay J, Lordkipanidzé M, Perrault L, Wells G, Bourke M, Rubens F, So D. ISCHEMIC AND BLEEDING OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING AMONG PATIENTS INITIALLY TREATED WITH A P2Y12 RECEPTOR ANTAGONIST FOR ACUTE CORONARY SYNDROMES - INSIGHTS ON TIMING OF DISCONTINUATION OF TICAGRELOR AND CLOPIDOGREL PRIOR TO SURGERY. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Healy DA, Boyle E, McCartan D, Bourke M, Medani M, Ferguson J, Yagoub H, Bashar K, O’Donnell M, Newell J, Canning C, McMonagle M, Dowdall J, Cross S, O'Daly S, Manning B, Fulton G, Kavanagh EG, Burke P, Grace PA, Moloney MC, Walsh SR. A MultiCenter Pilot Randomized Controlled Trial of Remote Ischemic Preconditioning in Major Vascular Surgery. Vasc Endovascular Surg 2015; 49:220-7. [DOI: 10.1177/1538574415614404] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A pilot randomized controlled trial that evaluated the effect of remote ischemic preconditioning (RIPC) on clinical outcomes following major vascular surgery was performed. Eligible patients were those scheduled to undergo open abdominal aortic aneurysm repair, endovascular aortic aneurysm repair, carotid endarterectomy, and lower limb revascularization procedures. Patients were randomized to RIPC or to control groups. The primary outcome was a composite clinical end point comprising any of cardiovascular death, myocardial infarction, new-onset arrhythmia, cardiac arrest, congestive cardiac failure, cerebrovascular accident, renal failure requiring renal replacement therapy, mesenteric ischemia, and urgent cardiac revascularization. Secondary outcomes were components of the primary outcome and myocardial injury as assessed by serum troponin values. The primary outcome occurred in 19 (19.2%) of 99 controls and 14 (14.1%) of 99 RIPC group patients ( P = .446). There were no significant differences in secondary outcomes. Our trial generated data that will guide future trials. Further trials are urgently needed.
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Affiliation(s)
- D. A. Healy
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - E. Boyle
- Department of Surgery Cork, University Hospital, Cork, Ireland
| | - D. McCartan
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - M. Bourke
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - M. Medani
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - J. Ferguson
- Department of Medicine, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - H. Yagoub
- Department of Medicine, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - K. Bashar
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - M. O’Donnell
- Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - J. Newell
- Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - C. Canning
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - M. McMonagle
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - J. Dowdall
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - S. Cross
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - S. O'Daly
- Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - B. Manning
- Department of Surgery Cork, University Hospital, Cork, Ireland
| | - G. Fulton
- Department of Surgery Cork, University Hospital, Cork, Ireland
| | - E. G. Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - P. Burke
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - P. A. Grace
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - M. Clarke Moloney
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - S. R. Walsh
- Department of Surgery, National University of Ireland Galway, Galway, Ireland
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McDonald B, Bourke M, Boodhwani M, Ruel M, Nikolla A, Dupuis J, Macdonald J. SURVIVAL AND QUALITY OF LIFE IN SURVIVORS OF PROLONGED CRITICAL ILLNESS FOLLOWING CARDIAC SURGERY: IS THE EFFORT WORTHWHILE? Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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16
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Kimmaliardjuk D, Al-Atassi T, Dagenais C, Bourke M, Lam B, Rubens F. SHOULD WE ABLATE ATRIAL FIBRILLATION DURING CORONARY ARTERY BYPASS GRAFTING AND AORTIC VALVE REPLACEMENT? Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Kollár D, McCartan DP, Bourke M, Cross KS, Dowdall J. Predicting acute appendicitis? A comparison of the Alvarado score, the Appendicitis Inflammatory Response Score and clinical assessment. World J Surg 2015; 39:104-9. [PMID: 25245432 DOI: 10.1007/s00268-014-2794-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients presenting with suspected appendicitis pose a diagnostic challenge. The appendicitis inflammatory response (AIR) score has outperformed the Alvarado score in two retrospective studies. The aim of this study was to evaluate the AIR Score and compare its performance in predicting risk of appendicitis to both the Alvarado score and the clinical impression of a senior surgeon. METHODS All parameters included in the AIR and Alvarado scores as well as the initial clinical impression of a senior surgeon were prospectively recorded on patients referred to the surgical on call team with acute right iliac fossa pain over a 6-month period. Predictions were correlated with the final diagnosis of appendicitis. RESULTS Appendicitis was the final diagnosis in 67 of 182 patients (37 %). The three methods of assessment stratified similar proportions (~40 %) of patients to a low probability of appendicitis (p = 0.233) with a false negative rate of <8 % that did not differ between the AIR score, Alvarado score or clinical assessment. The AIR score assigned a smaller proportion of patients to the high probability zone than the Alvarado score (14 vs. 45 %) but it did so with a substantially higher specificity (97 %) and positive predictive value (88 %) than the Alvarado score (76 and 65 %, respectively). CONCLUSIONS The AIR score is accurate at excluding appendicitis in those deemed low risk and more accurate at predicting appendicitis than the Alvarado score in those deemed high risk. Its use as the basis for selective CT imaging in those deemed medium risk should be considered.
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Affiliation(s)
- D Kollár
- Department of Surgery, Waterford Regional Hospital, Dunmore Road, Waterford, Republic of Ireland
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Kollár D, McCartan DP, Bourke M, Cross KS, Dowdall J. Erratum to: Predicting Acute Appendicitis? A Comparison of the Alvarado Score, the Appendicitis Inflammatory Response Score and Clinical Assessment. World J Surg 2014; 39:112. [DOI: 10.1007/s00268-014-2822-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Morris CL, Bourke M, Byler DD, Chen CF, Hogan G, Hunter JF, Kwiatkowski K, Mariam FG, McClellan KJ, Merrill F, Morley DJ, Saunders A. Qualitative comparison of bremsstrahlung X-rays and 800 MeV protons for tomography of urania fuel pellets. Rev Sci Instrum 2013; 84:023902. [PMID: 23464222 DOI: 10.1063/1.4789947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We present an assessment of x-rays and proton tomography as tools for studying the time dependence of the development of damage in fuel rods. We also show data taken with existing facilities at Los Alamos National Laboratory that support this assessment. Data on surrogate fuel rods have been taken using the 800 MeV proton radiography (pRad) facility at the Los Alamos Neutron Science Center (LANSCE), and with a 450 keV bremsstrahlung X-ray tomography facility. The proton radiography pRad facility at LANSCE can provide good position resolution (<70 μm has been demonstrate, 20 μm seems feasible with minor changes) for tomography on activated fuel rods. Bremsstrahlung x-rays may be able to provide better than 100 μm resolution but further development of sources, collimation, and detectors is necessary for x-rays to deal with the background radiation for tomography of activated fuel rods.
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Affiliation(s)
- C L Morris
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA.
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Salwa S, Bourke M, O'Shaughnessy M, O'Sullivan S, Kelly J, O'Sullivan G. Electrochemotherapy - a novel effective approach to naso-ocular basal cell carcinoma treatment. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Elmistekawy E, Chan V, Bourke M, Dupuis J, Rubens F, Mesana T, Ruel M. 102 OPCAB is not associated with better postoperative renal function compared to CABG. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Mahady SE, Bourke M. Visible peritoneal catheter during colonscopy. Endoscopy 2011; 43 Suppl 2 UCTN:E175. [PMID: 21557154 DOI: 10.1055/s-0030-1256268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S E Mahady
- Department of Gastroenterology, Westmead Hospital, Wentworthville, New South Wales 2145, Australia.
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Damodaran J, Bourke M, Dowling B. Preliminary evaluation after setting up a post-assessment attention deficit hyperactivity disorder clinic in a community setting. Ir J Med Sci 2011; 181:147-50. [PMID: 21479781 DOI: 10.1007/s11845-011-0710-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 03/30/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neuro-behavioural condition affecting school age children, older adolescents and young adults. It often leads to challenging educational, social and personal difficulties and co-morbidities which makes it an appropriate focus for the setting up of a dedicated clinic. AIM This service innovation was planned to ensure that ADHD patients receive regular multi-disciplinary reviews and to improve the training standards of junior doctors. We hypothesised that multimodal treatment approach shall be more acceptable to parents and children with ADHD than medication alone. It was our belief that the setting up of a post-assessment ADHD clinic will lead to efficient use of existing resources thereby saving clinical time. METHOD Our local audit identified 51 young people with ADHD stabilised on medication. One year after setting up the post-assessment ADHD clinic, feedback was obtained using questionnaires from clinicians and parents. RESULTS Seventy-five percent of parents and all the clinicians responded. Parents indicated that they were quite satisfied with the changes made. Clinicians were of the opinion that the dedicated ADHD clinic was more efficient in meeting the children's needs. CONCLUSION This survey validated our hypothesis that multi-modal reviews were more acceptable to parents of children with ADHD. The setting up of the dedicated clinic proved to be an efficient way of using the existing resources without any additional costs.
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Hansen CJ, Bourke M, Bridges NT, Byrne S, Colon C, Diniega S, Dundas C, Herkenhoff K, McEwen A, Mellon M, Portyankina G, Thomas N. Seasonal Erosion and Restoration of Mars’ Northern Polar Dunes. Science 2011; 331:575-8. [DOI: 10.1126/science.1197636] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- C. J. Hansen
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - M. Bourke
- Planetary Science Institute, Tucson, AZ 85719, USA
- School of Geography and the Environment, University of Oxford, Oxford OX1 3QY, UK
| | - N. T. Bridges
- Applied Physics Lab, John Hopkins University, Laurel, MD 20723, USA
| | - S. Byrne
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ 85721, USA
| | - C. Colon
- Department of Earth and Environmental Science, Rutgers University, Newark, NJ 07102, USA
| | - S. Diniega
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - C. Dundas
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ 85721, USA
| | | | - A. McEwen
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ 85721, USA
| | - M. Mellon
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80309, USA
| | - G. Portyankina
- Space Research and Planetology Division, University of Bern, CH-0132 Bern, Switzerland
| | - N. Thomas
- Space Research and Planetology Division, University of Bern, CH-0132 Bern, Switzerland
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Affiliation(s)
- M Bourke
- Department of Gastroenterology, Westmead Hospital, Westmead, New South Wales, Australia.
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Barry J, Bourke M, Buckley M, Coughlan B, Crowley D, Cullen W, Dooley S, Keating S, Kelleher D, Moloney J, Murray F, McCormick PA, MacMathuna P, O'Connor J, O'Grady J, O'Sullivan C, O'Sullivan P, Quinn C, Smyth B, Sweeney B. Hepatitis C among drug users: consensus guidelines on management in general practice. Ir J Med Sci 2004; 173:145-50. [PMID: 15693384 DOI: 10.1007/bf03167929] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hepatitis C (HCV) is a common cause of morbidity among patients who attend general practitioners (GPs) in Ireland for methadone maintenance treatment. AIMS To describe the development and content of guidelines for the management of HCV among current or former opiate users in the Eastern Regional Health Authority area attending GPs for methadone treatment. METHODS The guidelines were produced in five stages: identification of key stakeholders; development of evidence-based draft guidelines; discussion of content; determination of 'Delphi'-facilitated consensus and review by a sample of GPs for whom the guidelines would be intended. RESULTS The guidelines contain advice for GPs on all aspects of care of patients at risk of HCV, including general and preventative care, care of other bloodborne and hepatotoxic viruses, and the factors to be considered and appropriate evaluation prior to referring a patient for assessment at a hepatology unit. CONCLUSIONS GPs have an important role to play in the care of patients at risk of, or infected with, HCV.
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Affiliation(s)
- J Barry
- Eastern Regional Health Authority
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Affiliation(s)
- N De Luca
- Endoscopy Unit, Westmead Hospital, Westmead, NSW, Australia
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Dupuis JY, Wang F, Nathan H, Lam M, Grimes S, Bourke M. The cardiac anesthesia risk evaluation score: a clinically useful predictor of mortality and morbidity after cardiac surgery. Anesthesiology 2001; 94:194-204. [PMID: 11176081 DOI: 10.1097/00000542-200102000-00006] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Cardiac Anesthesia Risk Evaluation (CARE) score is a simple risk classification for cardiac surgical patients. It is based on clinical judgment and three clinical variables: comorbid conditions categorized as controlled or uncontrolled, surgical complexity, and urgency of the procedure. This study compared the CARE score with the Parsonnet, Tuman, and Tu multifactorial risk indexes for prediction of mortality and morbidity after cardiac surgery. METHODS In this prospective study, 3,548 cardiac surgical patients from one institution were risk stratified by two investigators using the CARE score and the three tested multifactorial risk indexes. All patients were also given a CARE score by their attending cardiac anesthesiologist. The first 2,000 patients served as a reference group to determine discrimination of each classification with receiver operating characteristic curves. The following 1,548 patients were used to evaluate calibration using the Pearson chi-square goodness-of-fit test. RESULTS The areas under the receiver operating characteristic curves for mortality and morbidity were 0.801 and 0.721, respectively, with the CARE score rating by the investigators; 0.786 and 0.710, respectively, with the CARE score rating by the attending anesthesiologists (n = 8); 0.808 and 0.726, respectively, with the Parsonnet index; 0.782 and 0.697, respectively, with the Tuman index; 0.770 and 0.724 with the Tu index, respectively. All risk models had acceptable calibration in predicting mortality and morbidity, except for the Parsonnet classification, which failed calibration for morbidity (P = 0.026). CONCLUSIONS The CARE score performs as well as multifactorial risk indexes for outcome prediction in cardiac surgery. Cardiac anesthesiologists can integrate this score in their practice and predict patient outcome with acceptable accuracy.
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Affiliation(s)
- J Y Dupuis
- Department of Anesthesia, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Abstract
A patient with chronic thromboembolic pulmonary hypertension and heparin-induced thrombocytopenia successfully underwent pulmonary thromboendarterectomy with circulatory arrest, using recombinant hirudin as an alternative anticoagulant to heparin. Techniques for administration as well as monitoring of this drug's effects are discussed.
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Affiliation(s)
- F D Rubens
- Department of Surgery, University of Ottawa, Ontario, Canada.
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Langton D, Hickey A, Bury G, Smith M, O'Kelly F, Barry J, Sweeney B, Bourke M. Methadone maintenance in general practice: impact on staff attitudes. Ir J Med Sci 2000; 169:133-6. [PMID: 11006672 DOI: 10.1007/bf03166918] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The evaluation of a structured protocol for the discharge of stabilised patients on methadone maintenance to general practice provided an opportunity to evaluate the impact on the attitudes of general practitioners (GPs) and practice staff. AIM To assess attitudes, expectations and experience among GPs and practice staff before the introduction of structured methadone maintenance and six months after its introduction. METHODS A postal questionnaire was sent to 31 GPs and 23 receptionists in 23 Dublin general practices before the patient's first visit and six months later at the end of the study period. Outcome measures were staff attitudes, incidence of disruption, perceived difficulties in providing care and in prescribing methadone, and stress levels. RESULTS There was a generally positive attitude to provision of methadone in general practice for stabilised patients, although it was not anticipated to be problem free. Following six months involvement attitudes were similar; stress levels were unchanged, but fewer GPs anticipated problems in delivering the service. All continued to participate in the scheme. CONCLUSION GPs and receptionists in this sample had mixed views about methadone maintenance which were unchanged by six months experience of the service. The study illustrates important issues in the recruitment and support of general practice in meeting this need.
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Affiliation(s)
- D Langton
- Department of General Practice, University College Dublin, Ireland
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Bourke M, Hayes A, Doyle M, McCarroll M. A comparison of regularly administered sustained release oral morphine with intramuscular morphine for control of postoperative pain. Anesth Analg 2000; 90:427-30. [PMID: 10648333 DOI: 10.1097/00000539-200002000-00034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED We studied the efficacy and side effect profile of regularly administered, oral sustained-release morphine sulfate tablets (MST) and IM morphine in patients undergoing total hip arthroplasty under lumbar spinal anesthesia. Patients in Group I received MST 20 mg 12 hourly and a placebo IM injection 6 hourly regularly. Group II patients received an oral placebo 12 hourly and morphine sulfate 10 mg IM 6 hourly regularly. Rescue analgesia was provided with regular diclofenac suppositories and patient-controlled analgesia. Pain scores assessed by using visual analog scale and verbal pain scoring at rest and with movement were low in both groups, with no statistical difference between groups. Mean patient-controlled analgesia morphine consumption during the 48-h study was 16.7 mg in the IM group and 25.9 mg in the MST group. The difference between the groups was significant at 36 h postoperatively (0.03). Side effects of sedation and respiratory depression were not problematic in either group, with a maximal sedation score of 2 occurring once in a patient in Group II. Nausea and vomiting occurred more often in Group II, but this was not statistically significant, with a mean nausea/vomiting score for Group II of 1.7. We conclude that oral, sustained-release morphine is an attractive alternative to IM opiates in patients undergoing body surface surgery under regional anesthesia. IMPLICATIONS Each postoperative analgesic has its own limitations for route of administration, dosage, and potential side effects. Using the oral route for drug administration seems more attractive than other methods but may not be suitable in all postoperative patients. We studied the efficacy and side effect profile of sustained-release, oral morphine compared with standard IM morphine for the treatment of pain after hip replacement surgery. We concluded that use of the oral preparation is a suitable alternative to the IM route in this population undergoing surgery under spinal anesthesia.
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MESH Headings
- Administration, Oral
- Aged
- Analgesia, Patient-Controlled
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Analgesics, Opioid/therapeutic use
- Anesthesia, Spinal
- Arthroplasty, Replacement, Hip
- Delayed-Action Preparations
- Female
- Humans
- Injections, Intramuscular
- Male
- Morphine/administration & dosage
- Morphine/adverse effects
- Morphine/therapeutic use
- Pain Measurement
- Pain, Postoperative/drug therapy
- Postoperative Nausea and Vomiting/etiology
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Affiliation(s)
- M Bourke
- Department of Anesthesia, Cappagh Orthopaedic Hospital, Dublin, Ireland
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Abstract
BACKGROUND There are only limited treatment options for patients with chronic thromboembolic pulmonary hypertension in Canada. OBJECTIVE To conduct a case-series study to assess the effectiveness of surgical endarterectomy of the pulmonary artery. DESIGN AND SETTING Twenty-one patients with chronic thromboembolic pulmonary hypertension were admitted for surgery between July 1995 and October 1999. Clinical, laboratory and radiological data were collected for all patients who then underwent pulmonary thromboendarterectomy. MAIN RESULTS Thirteen men and eight women between 22 and 71 years of age underwent surgery. The main presenting complaint was dyspnea on exertion. Pulmonary vascular resistance ranged from 382 to 1694 dynes s cm-5 with a mean of 765+/-372 dynes s cm-5 (normal is less than 180 dynes s cm-5) with a mean cardiac index of 2.2+/-0.9 L/min/m2. Two patients had concomitant tricuspid valve replacement and one patient had coronary bypass grafting. In three cases, the surgery involved a repeat sternotomy. After surgery, there was a significant drop in the pulmonary vascular resistance (208+/-92 dynes s cm-5, P<0.05) and a concomitant rise in the cardiac index to a mean of 3.1+/-0.6 L/min/m2 (P<0.05). There was one death in a patient who also had severe chronic obstructive pulmonary disease. Of the remaining patients, all but two showed significant clinical improvement. Spiral computed tomography postsurgery demonstrated improvement in pulmonary perfusion with either complete clearing or significant improvement in the mosaic perfusion pattern. Right ventricular function and pressure on echocardiogram improved in all but two patients. CONCLUSIONS Pulmonary thromboendarterectomy provides effective treatment for chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
- F Rubens
- University of Ottawa Heart Institute, Ottawa, Canada.
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Abstract
In this series of experiments, the Unified System components of the HeartSaver Ventricular Assist Device (VAD) version 5.0 were isolated from the controller and power supply for independent assessment. Five systems with external controller/power supply via a percutaneous lead configuration were tested in 13 male calves (101.8+/-4.3 kg). Two studies were ended acutely because of improper filling and air embolism, respectively. Duration of support was from 2.2 hours to 30 days (mean, 99+/-62 hours). The 30 day survivor was euthanized electively. Study termination was related to postoperative complications in five calves: two with bleeding/tamponade, one with thromboembolism caused by inadequate anticoagulation, and two with respiratory insufficiency. Other causes of termination were: one caused by main building power failure, two from errors in communication between the device and controller, and two caused by hydraulic fluid loss related to housing defects. From these experiments, an intrathoracic position for the calf has been defined, the procedure for implantation without cardiopulmonary bypass has been developed, refinements to the controller have been made, and inflow and outflow cannulae have been reinforced. Hydraulic fluid losses will be solved by proceeding with use of a titanium housing instead of polyurethane. In conclusion, the development of the HeartSaver VAD is progressing, in part because of these experimental and informative animal studies. Further in vivo evaluation of the final version will be conducted before clinical trials.
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Affiliation(s)
- P Hendry
- Department of Cardiac Surgery, University of Ottawa Heart Institute, Canada
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Clarke G, Ryan E, O’Keane JC, Crowe J, McMathuna P, Moriarty D, Ettarh R, Sheahan K, Hyland J, O’Donoghue DP, Baird AW, Clarke G, Ryan E, Gormley G, Keane JCO, Crowe J, MacMathuna P, Wang JH, Wu QD, Redmond HP, Condron C, Bouchier-Hayes D, Nally K, Newton F, O’Connell J, O’Sullivan GC, Morgan J, Collins JK, Shanahan F, Goode C, O’Connell J, O’Sullivan GC, Collins JK, Shanahan F, Winter DC, Taylor CT, Skelly MM, O’Donoghue DP, O’Sullivan GC, Baird AW, Harvey BJ, Varghese JC, Farrell MA, McGrath FP, Murray FE, Osborne H, Lee MJ, Ryan E, Sullivan A, O’Keane JC, Crowe J, Ryan AE, O’Keane JC, Crowe J, Donovan AN, McCormick PA, Kenny B, Somers S, Bohan A, Gibney RG, Marcaccio M, Malone DE, Doyle M, Delaney CP, Gorey TF, McEntee GP, O’Sullivan GC, Clarke A, Stuart R, Kelly J, Kiely MD, Collins JK, Shanahan F, O’Sullivan M, Lovett E, Mahmud N, Kelleher D, O’Morain CA, Larkin CJ, Watson RGP, Sloan JM, Ardill JES, Johnston CF, Buchanan KD, Heaney A, Collins JSA, Watson GRP, Kalin RM, Heaney A, Collins JSA, Tham TCK, Watson RGP, McFarland RJ, Bamford KB, Cróinín TÓ, Clyne M, Drumm B, Rowland M, Kumar D, O’Connor P, Daly LE, Drumm B, O’Toole DL, Long A, Murphy AM, O’Neill L, Weir DG, Kelleher D, Heaney A, Collins JSA, Watson RGP, Hopkins AM, Moynagh P, O’Donoghue DP, Baird AW, Brennan C, Harmey J, Stapleton PP, Redmond HP, Bouchier-Hayes D, Rasheed AM, Chen G, Kelly C, Bouchier-Hayes DJ, Leahy A, Gallagher M, Grace A, Xin Y, Leader M, Kay E, Whelan A, Pattison U, Willoughby R, Wallace E, Weir D, Feighery C, Bennett MW, O’Connell J, O’Sullivan GC, Brady C, Roche D, Collins JK, Shanahan F, Mahmud N, Molloy A, McPartlin J, Scott JM, Weir DG, Acheson AG, Lee J, Khosraviani K, Irwin ST, McDaid J, McCormick PA, Docherty JR, O’Grady A, Kay E, Mabruk M, Grace A, Leader M, Lee J, Acheson AG, Irwin ST, Larkin CJ, Johnston C, Curry W, Ardill J, Cunningham R, Buchanan KD, Watson RGP, McDougall NI, Coyle PV, Callender ME, Ouinn AM, Warner R, Stevens FM, Chakravarthi PIS, Kearns M, Bourke M, Hassan A, McWeeney J, Stevens FM, McCarthy CF, Casey M, O’Donoghue J, Eustace-Ryan AM, O’Regan P, Feighery L, Jackson J, Cronin N, Shanahan F, Quane K, Feighery C, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, O’Sulhvan M, Harman I, Breslin NP, Clayton N, O’Morain CA, Hogan S, Donovan B, Hayes D, Kiely M, Eustace-Ryan AM, O’Regan P, Goulding CA, Albloushi SS, O’Connor J, Courtney MG, Murray FE, Albloushi SS, Goulding CA, Kay E, Royston D, Leader M, Courtney MG, Murray FE, Albloushi SS, Kay E, Goulding CA, Grace A, O’Connor J, Shattock AG, Courtney MG, Murray FE, Albloushi SS, Stack A, Kay E, Goulding CA, Carmody M, Murray FE, Courtney MG, Barrett S, Ryan E, O’Keane JC, Crowe J, Hennigan A, Delaney CP, Young L, Shields CJ, O’Keane C, Gorey TF, Fitzpatrick JM, Rasheed AM, Wang JH, Kelly C, Bouchier-Hayes DJ, Leahy A, Doyle MM, Stephens RB, Daly PA, Bennett MW, O’Connell J, O’Sullivan GC, Brady C, Roche D, Collins JK, Shanahan F, Briggs GM, McCrory D, Briggs GM, McCrory D, O’Neill S, O’Grady H, Grant DC, Barry K, Traynor O, Hyland JMP, O’Toole GC, Grant DC, Barry MK, Hyland JMP, Johnston SD, Ritchie CM, Robinson TJ, Johnston SD, Kirby JM, Mackle EM, Robinson TJ, Haider N, Aherne N, McNichol F, Hamilton D, Neary P, Hegarty S, Connor JO, Watson RGK, Drudy D, Alwan A, Fenelon L, O’Farrelly C, Hyland J, Byrne B, Madrigal L, Carton J, Collins C, O’Donoghue D, O’Farrelly C, Gannon N, Hickey A, O’Boyle CA, Byrne R, Albloushi S, Murray F. Irish society of gastroenterology. Ir J Med Sci 1998. [DOI: 10.1007/bf02937896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
- M Bourke
- School of Veterinary Studies, Murdoch University, Western Australia
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Bourke M. Culture in the workplace. Lamp 1997; 54:32. [PMID: 9325853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Nepean Hospital is the major tertiary referral hospital in the Wentworth Area Health Service, extending in area from Katoomba to Mt. Druitt to Windsor. The Wentworth area has one of the highest population growth rates in NSW and it is estimated that by the year 2000 the population will be 302,000, of which approximately 7% will be of a non-English speaking background (NESB).
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Affiliation(s)
- M Bourke
- Division of Women's and Children's Health, Nepean Hospital
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Hendry PJ, Masters RG, Keaney M, Bourke M, Mussivand T, Keon WJ. Evolution of an electrohydraulic ventricular assist device through in vivo testing. The EVAD Team. ASAIO J 1996; 42:M350-4. [PMID: 8944905 DOI: 10.1097/00002480-199609000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A totally implantable intrathoracic electrohydraulic ventricular assist device has been developed at the University of Ottawa Heart Institute. In vivo testing has been instrumental in its progressive development. A total of 15 experiments (4 acute, 11 performance) have been performed using male calves (62-117 kg). Data from the acute experiments, human fit trials, fluid dynamic studies, and hydraulic/energy efficiency analyses formed the basis for the development of a compact, single piece ventricular assist device called the Unified System in which the volume displacement chamber, motor, and blood chamber are housed within a compact 600 cc, 740 g unit. The performance experiments indicated that the unified system could support calves for periods up to 96 hr. The mean postoperative cardiac output was 7.1 +/- 0.7 L/ min (range = 4.9-11), mean blood pressure was 99.7 +/- 5.8 mmHg, and mean pulmonary artery pressure was 32.1 +/- 1.2 mmHg. The operative technique for intrathoracic implantation has been developed. The major problems encountered were of respiratory failure, improved by device repositioning in the calf; decreased blood inflow to the device that was improved by cannula redesign; circuit board fracture corrected by design modification; and a power supply problem that was limited to a single unit. The preliminary experiments have helped in the design modifications of the Unified System. The improved version of the system will undergo formal performance, reliability, and chronic in vivo testing before human implantation.
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Affiliation(s)
- P J Hendry
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ontario, Canada
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Affiliation(s)
- O K Steinmetz
- Department of Surgery, University of Ottawa, Ontario, Canada
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Heinrichs AA, Bortell R, Bourke M, Lian JB, Stein GS, Stein JL. Proximal promoter binding protein contributes to developmental, tissue-restricted expression of the rat osteocalcin gene. J Cell Biochem 1995; 57:90-100. [PMID: 7721961 DOI: 10.1002/jcb.240570110] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Osteocalcin is a 6 kD tissue-specific calcium binding protein associated with the bone extracellular matrix. The osteocalcin gene is developmentally expressed in postoproliferative rat osteoblasts with regulation at least in part at the transcriptional level. Multiple, basal promoter and enhancer elements which control transcriptional activity in response to physiological mediators, including steroid hormones, have been identified in the modularly organized osteocalcin gene promoter. The osteocalcin box (OC box) is a highly conserved basal regulatory element residing between nucleotides -99 and -76 of the proximal promoter. We recently established by in vivo competition analysis that protein interactions at the CCAAT motif, which is the central core of the rat OC box, are required for support of basal transcription [Heinrichs et al. J Cell Biochem 53:240-250, 1993]. In this study, by the combined utilization of electrophoretic mobility shift analysis, UV cross linking, and DNA affinity chromatography, we have identified a protein that binds to the rat OC box. Results are presented that support involvement of the OC box-binding protein in regulating selective expression of the osteocalcin gene during differentiation of the rat osteoblast phenotype and suggest that this protein is tissue restricted.
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Affiliation(s)
- A A Heinrichs
- Department of Cell Biology, University of Massachusetts Medical Center, Worcester 01655-0106
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Carson KD, Grimes SB, McGinley JM, Thornton MT, Mulhall J, Bourke AM, McCrory C, Marsh B, Hone R, Phelan D, White M, Fabry J, Hughes D, Carson K, Donnelly M, Shanahan E, Fitzpatrick GJ, Bourke M, Warde D, Buggy D, Hughes N, Taylor A, Dowd N, Markham T, Blunnie W, Nicholson G, O’Leary E, Cunningham AJ, Dwyer R, McMechan S, Cullen C, Dempsey G, Wright G, MacKenzie G, Anderson J, Adgey J, Walsh M, O’Callaghan P, Graham I, O’Hare JA, Geoghegan M, Iman N, Shah P, Chander R, Lavin F, Daly K, Johnston PW, Imam Z, Adgey AAJ, Rusk RA, Richardson SG, Hale A, Kinsella BM, FitzGerald GA, King G, Crean P, Gearty G, Cawley T, Docherty JR, Geraghty J, Osborne H, Upton J, D’Arcy G, Stinson J, Cooke T, Colgan MP, Hall M, Tyrrell J, Gaffney K, Grouden M, Moore DJ, Shanik G, Feely J, Delanty N, Reilly M, Lawson JA, Fitzgerald DJ, Reilly MP, McAdam BF, Bergin C, Walshe MJ, Herity NA, Allen JD, Silke B, Singh HP, O’Neill S, Hargrove M, Coleman E, Shorten E, Aherne T, Kelly BE, Hill DH, McIlrath E, Morrow BC, Lavery GG, Blackwood B, Fee JPH, Kevin L, Doran M, Tansey D, Boylan I, McShane AJ, O’Reilly G, Tuohy B, Grainger P, Larkin T, Mahady J, Malone J, Condon C, Donoghue T, O’Leary J, Lyons JF, Tay YK, Tham SN, Khoo Tan HS, Gibson G, O’Grady A, Leader M, Walshe J, Carmody M, Donohoe J, Murphy GM, O’Connor W, Barnes L, Watson R, Darby C, O’Moore R, Mulcahy F, O’Toole E, O’Briain DS, Young MM, Buckley D, Healy E, Rogers S, Ni Scannlain N, McKenna MJ, McBrinn Y, Murray B, Freaney R, Barrett E, Razza Q, Abuaisha F, Powell D, Murray TM, Powell AM, O’Mongain E, O’Neill J, Kernan RP, O’Connor P, Clarke D, Fearon U, Cunningham SK, McKenna TJ, Hayes F, Heffernan A, Sheahan K, Harper R, Johnston GD, Atkinson AB, Sheridan B, Bell PM, Heaney AP, Loughrey G, McCance DR, Hadden DR, Kennedy AL, McNamara P, O’Shaughnessy C, Loughrey HC, Reid I, Teahan S, Caldwell M, Walsh TN, McSweeney J, Hennessy TP, Caldwell MTP, Byrne PJ, Hennessy TPJ, El-Magbri AA, Stevens FM, O’Sullivan R, McCarthy CF, Laundon J, Heneghan MA, Kearns M, Goulding J, Egan EL, McMahon BP, Hegarty F, Malone JF, Merriman R, MacMathuna P, Crowe J, Lennon J, White P, Clarke E, Prabhakar MC, Ryan E, Graham D, Yeoh PL, Kelly P, McKeogh D, O’Keane C, Kitching A, Mulligan E, Gorey TF, Mahmud N, O’Connell M, Goggins M, Keeling PWN, Weir DG, Kelleher D, McDonald GSA, Maguire D, O’Sullivan G, Harvey B, Cherukuri A, McGrath JP, Timon C, Lawlor P, O’Shea J, Buckley M, English L, Walsh T, O’Morain C, Lavelle SM, Kanagaratnam B, Harding B, Murphy B, Kavanagh J, Kerr D, Lavelle E, O’Gorman T, Liston S, Fitzpatrick C, Fitzpatrick P, Turner M, Murphy AW, Cafferty D, Dowling J, Bury G, Kaf Al-Ghazal S, Zimmermann E, O’Donoghue J, McCann J, Sheehan C, Boissel L, Lynch M, Cryan B, Fanning S, O’Meara D, Fennell J, Byrne PM, Lyons D, Mulcahy R, Pooransingh A, Walsh JB, Coakley D, O’Neill D, Ryall N, Connolly P, Namushi R, Lawler M, Locasciulli A, Bacigalupo A, Humphries P, McCann SR, Pamphilon D, Reidy M, Madden M, Finch T, Borton M, Barnes CA, Lawlor SE, Gardiner N, Egan LJ, Orren A, Doherty J, Curran C, O’Hanlon D, Kent P, Kerin M, Maher D, Given HF, Lynch S, McManus R, O’Farrelly C, Madrigal L, Feighery C, O’Donoghue D, Whelan CA, Rea IM, Stewart M, Campbell P, Alexander HD, Crockard AD, Morris TCM, Maguire H, Davidson F, Kaminski GZ, Butler K, Hillary IB, Parfrey NA, Crowley B, McCreary C, Keane C, O’Reilly M, Goh J, Kennedy M, Fitzgerald M, Scott T, Murphy S, Hildebrand J, Holliman R, Smith C, Kengasu K, Riain UN, Cormican M, Flynn J, Glennon M, Smith T, Whyte D, Keane CT, Barry T, Noone D, Maher M, Dawson M, Gilmartin JJ, Gannon F, Eljamel MS, Allcut D, Pidgeon CN, Phillips J, Rawluk D, Young S, Toland J, Deveney AM, Waddington JL, O’Brien DP, Hickey A, Maguire E, Phillips JP, Al-Ansari N, Cunney R, Smyth E, Sharif S, Eljamel M, Pidgeon C, Maguire EA, Burke ET, Staunton H, O’Riordan JI, Hutchinson M, Norton M, McGeeney B, O’Connor M, Redmond JMT, Feely S, Boyle G, McAuliffe F, Foley M, Kelehan P, Murphy J, Greene RA, Higgins J, Darling M, Byrne P, Kondaveeti U, Gordon AC, Hennelly B, Woods T, Harrison RF, Geary M, Sutherst JR, Turner MJ, DeLancey JOL, Donnelly VS, O’Connell PR, O’Herlihy C, Barry-Kinsella C, Sharma SC, Drury L, Lewis S, Stratton J, Ni Scanaill S, Stuart B, Hickey K, Coulter-Smith S, Moloney A, Robson MS, Murphy M, Keane D, Stronge J, Boylan P, Gonsalves R, Blankson S, McGuinness E, Sheppard B, Bonnar J, MacDonagh-White CM, Kelleher CC, Newell J, White O, Young Y, Hallahan C, Carroll K, Tipton K, McDermott EW, Reynolds JV, Nolan N, McCann A, Rafferty R, Sweeney P, Carney D, O’Higgins NJ, Duffy MJ, Grimes H, Gallagher S, O’Hanlon DM, Strattan J, Lenehan P, Robson M, Cusack YA, O’Riordain D, Mercer PM, Smyth PPA, Gallagher HJ, Moule B, Cooke TG, McArdle CS, Burke C, Vance A, Saidtéar C, Early A, Eustace P, Maguire L, Cullinane ABP, Prosser ES, Coca-Prados M, Harvey BJ, Saidléar C, Orwa S, Fitzsimons RB, Bradley O, Hogan M, Zimmerman L, Wang J, Kuliszewski M, Liu J, Post M, Premkumar, Conran MJ, Nolan G, Duff D, Oslizlok P, Denham B, O’Connell PA, Birthistle K, Hitchcock R, Carrington D, Calvert S, Holmes K, Smith DF, Hetherton AM, Mott MG, Oakhill A, Foreman N, Foot A, Dixon J, Walsh S, Mortimer G, O’Sullivan C, Kilgallen CM, Sweeney EC, Brayden DJ, Kelly JG, McCormack PME, Hayes C, Johnson Z, Dack P, Hosseini J, O’Connell T, Hemeryck L, Condren L, McCormack P, McAdam B, Lawson J, Keimowitz R, O’Leary A, Pilkington R, Adebayo GI, Gaffney P, McGettigan P, McManus J, O’Shea B, Wen Y, Killalea S, Golden J, Swanwick G, Clare AW, Mulvany F, Byrne M, O’Callaghan E, Byrne H, Cannon N, Kinsella T, Cassidy B, Shepard N, Horgan R, Larkin C, Cotter D, Coffey VP, Sham PC, Murray LH, Lane A, Kinsella A, Murphy P, Colgan K, Sloan D, Gilligan P, McEnri J, Ennis JT, Stack J, Corcoran E, Walsh D, Thornton L, Temperley I, Lawlor E, Tobin A, Hillary I, Nelson HG, Martin M, Ryan FM, Christie MA, Murray D, Keane E, Holmes E, Hollyer J, Strangeways J, Foster P, Stanwell-Smith R, Griffin E, Conlon T, Hayes E, Clarke T, Fogarty J, Moloney AC, Killeen P, Farrell S, Clancy L, Hynes M, Conlon C, Foley-Nolan C, Shelley E, Collins C, McNamara E, Hayes B, Creamer E, LaFoy M, Costigan P, Al fnAnsari N, Cunney RJ, Smyth EG, Johnson H, McQuoid G, Gilmer B, Browne G, Keogh JAB, Jefferson A, Smith M, Hennessy S, Burke CM, Sreenan S, Power CK, Pathmakanthan S, Poulter LW, Chan A, Sheehan M, Maguire M, O’Connor CM, FitzGerald MX, Southey A, Costello CM, McQuaid K, Urbach V, Thomas S, Horwitz ER, Mulherin D, FitzGerald O, Bresnihan B, Kirk G, Veale DJ, Belch JJF, Mofidi A, Mofidi R, Quigley C, McLaren M, Veale D, D’Arrigo C, Couto JC, Woof J, Greer M, Cree I, Belch J, Hone S, Fenton J, Hamilton S, McShane D. National Scientific Medical Meeting 1994 Abstracts. Ir J Med Sci 1994. [DOI: 10.1007/bf02943102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
This randomized double-blind study compared the hemodynamic and metabolic effects of pancuronium and vecuronium during treatment of shivering after cardiac surgery with hypothermic cardiopulmonary bypass. Thirty sedated and pain-free patients who shivered after cardiac surgery were treated with pancuronium (n = 15) or vecuronium (n = 15) 0.08 mg/kg. Baseline values of heart rate (HR), mean arterial pressure, arterial and venous blood gases, total body oxygen consumption indexed to body surface area (VO2-I), and pressure work index (PWI, an estimate of myocardial oxygen consumption) were measured on arrival in the intensive care unit, at onset of shivering, and repeatedly for 2 h after treatment. Continuous ST segment analysis of leads II and V5 were used for detection of myocardial ischemia. Treatment of shivering with pancuronium decreased VO2-I by 32% (P = 0.0001). This was accompanied by a 14% increase in HR (P = 0.001) and a 10% increase in PWI (P = 0.03). Vecuronium decreased VO2-I by 36% (P = 0.003) with a 4% decrease in HR (P = 0.04) and a 6% decrease in PWI (P = 0.06). Myocardial ischemia (n = 3) and ventricular arrhythmias (n = 3) occurred in five patients treated with pancuronium. Only one patient treated with vecuronium had ventricular arrhythmia (P = 0.08). Seven patients treated with pancuronium and eight treated with vecuronium were taking beta-adrenergic blockers preoperatively which was associated with lower HR (96 +/- 16 vs 109 +/- 15 bpm; P = 0.025) and lower PWI (8.8 +/- 1.2 vs 10.7 +/- 1.92 mL.min-1 x 100 g-1; P = 0.003) at onset of shivering. However, beta-adrenergic blockers did not attenuate the relative HR increase induced by pancuronium. No relationship was found between hypercapnia and tachycardia or hypertension. These results suggest that, when compared to pancuronium for treatment of postoperative shivering, vecuronium may be advantageous because it does not increase myocardial work. The disproportionate relationship between VO2-I and PWI after treatment with muscle relaxants indicates that increased VO2-I does not contribute significantly to the hemodynamic disturbances associated with shivering. These disturbances are more likely the results of increased adrenergic activity related to pain and recovery from anesthesia. Shivering and its associated hemodynamic disturbances appear to be concomitant but independent signs of awakening.
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Affiliation(s)
- J Y Dupuis
- Department of Anesthesia, University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario, Canada
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Bourke M, O'Donovan M, Stevens FM, McCarthy CF. Alpha 1-antitrypsin phenotypes in coeliac patients and a control population in the west of Ireland. Ir J Med Sci 1993; 162:171-2. [PMID: 8335451 DOI: 10.1007/bf02945176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
alpha 1 antitrypsin or protease inhibitor (Pi) phenotyping was carried out on 111 coeliac disease patients (CD) and 250 controls. The Pi MM phenotype was present in 95 (85.6%) of the coeliacs and 225 (90%) of the controls. The groups did not differ significantly with regard to Pi phenotypes. In the CD group the Pi Phenotype did not relate to HLA B8 or DR3 status. Associated diseases in the CD patients did not correlate with Pi phenotype.
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Affiliation(s)
- M Bourke
- Department of Medicine, University College Hospital, Galway
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Nathan HJ, Laganière S, Dubé L, Foster B, McGilveray I, Harrison M, Bourke M, Cattran C, de LaSalle G, Robblee J. Intravenous nifedipine to treat hypertension after coronary artery revascularization surgery. A comparison with sodium nitroprusside. Anesth Analg 1992; 74:809-17. [PMID: 1595912 DOI: 10.1213/00000539-199206000-00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We administered sodium nitroprusside (SNP) or nifedipine intravenously to patients who became hypertensive after elective coronary revascularization and compared their effects on hemodynamics and the electrocardiogram in a parallel, randomized, open-label study. Four of 21 patients treated with nifedipine required the addition of SNP to maintain mean arterial pressure less than 90 mm Hg, compared with 4 of 28 patients in the SNP group who required the addition of nifedipine. The success rates of nifedipine (81%) and SNP (86%) were not significantly different. There was no difference in the incidence of adverse ST-segment changes during drug infusion (4% versus 5%) or perioperative myocardial infarction (9.5% versus 10.7%) in the nifedipine versus SNP groups, respectively. The plasma nifedipine concentration (mean value +/- SD) at steady state for 21 patients receiving nifedipine was 119 +/- 42.5 ng/mL. The pharmacokinetic variables for nifedipine were as follows (mean values +/- SD): systemic clearance, 0.525 +/- 0.228 L.h-1.kg-1; apparent volume of distribution, 0.738 +/- 0.446 L/kg; and elimination half-life, 1.02 +/- 0.51 h. These values are similar to those reported previously in healthy volunteers. We conclude that intravenous nifedipine can be used safely to control hypertension after coronary revascularization but were unable to demonstrate an advantage of nifedipine compared with SNP in preventing postoperative ischemia or infarction in this group of patients who had good left ventricular function.
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Affiliation(s)
- H J Nathan
- Department of Anesthesia, University of Ottawa, Ontario, Canada
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Korzeniewski P, Lang SA, Grant R, Loader C, Vaghadia H, Wong D, Waters T, Merrick P, Ali MJ, Dobkowski W, Cornelius T, Hawkins R, Varkey GP, Claffey L, Plourde G, Trahan M, Morris J, Dean DM, Yamaguchi H, Harukuni I, Naito H, Chan VWS, Mati N, Seyone C, Evans D, Chung F, Joffe D, Plourde G, Villemurc C, Hong M, Milne B, Loomis C, Jhamandas K, Priddy R, Archer D, Tang T, Sabourin M, Samanini N, Cuillerier DJ, Schuben A, Awad IA, Perez-Trepichio AD, Ebrahim ZY, Bloomfield EL, Zexu F, Zhengnua G, Qing Z, Balhua S, Miller DR, Martineau RJ, Wynands JE, Hill JD, Knill RL, Skinner MI, Novick TV, McLean RF, Kolton M, Noble WH, Sullivan PJ, Cheng DCH, Chapman KR, Ong D, Roraanelli J, Smallman B, Nathan HJ, Murphy JT, Hall RI, Moffitt EA, Hudson RJ, Pascoe EA, Anderson BA, Thomson IR, Kassum DA, Shanks A, Rosenbloom M, Sidi A, Gehrig TR, Fool JM, Rush W, Martin AJ, Cooper PD, Maltby JR, Johnson D, Hurst T, Mayers I, Wigglesworth DF, Rose DK, Kay JC, Mazer CD, Yang H, Beattie WS, Doyle DJ, Demajo W, Comfort VK, Code WE, Rooney ME, Clark FJS, Sutton IR, Mutch WAC, Thomson IR, Teskey JM, Thiessen OB, Rosanbloom M, Tang TKK, Robblee JA, Nathan HJ, Wynands JE, Eagle CJ, Belenkle I, Chan KL, Tyberg JV, Stockwell M, Zintel T, Gallagher G, Kavanagh B, Sandier A, Lawson S, Chung F, Ong D, Isabel L, Trépanier CA, Campbell DC, Randall TE, Growe GH, Scarth I, Sawchuk CWT, Ong B, Unruh H, Horan T, Greengrass R, Mark D, Kitts JB, Curran MJ, Lindsay P, Polis T, Coté S, Socci M, Wiesel S, Conway JB, Seyone C, Goldberg J, Chung F, Rose DK, Cohen MM, Rogers KH, Duncan PG, Pope WDB, Tweed WA, Biehl D, Novick TV, Skinner MI, Mathieu A, Villeneuve E, Goldsmith CH, Allen GC, Smith CE, Pinchak AC, Hagen JF, Hudson JC, Gennings C, Tyler BL, Keenan RL, Chung F, Seyone C, Matl N, Ong D, Powell P, Tessler MJ, Kleiman SJ, Wiesel S, Tetzlaff JE, Yoon HJ, Baird B, Walsh M, Hondorp G, Wassef MR, Munshi C, Brooks J, Nimphius N, Tweed WA, Lee TL, Tweed WA, Phua WT, Chong KY, Lim E, Finegan BA, Coulson C, Lopaschuk GD, Clanachan AS, Fournier L, Cloutier R, Major D, Sharpe MD, Wexler HR, Dhamee MS, Rooney R, Ong SK, O’Leary E, McCarroll M, Phelan D, Young T, Coghlan D, O’Leary E, Blunnie WP, Splinter WM, Splinter WM, Ryan T, Maguire M, Bouchier-Hayes D, Cunningham AJ, Kamath MV, Fallen EL, Murkin JM, Shannon NA, Montgomery CJ, Karl HW, Raymond J, Drolet P, Tanguay M, Blaise G, Garceau D, Dumont L, Omri A, Sharkawi M, Billard V, Bourgain JL, Panos A, Mazer CD, Lichtenstein SV, Bevan JC, Popovic V, Baxter MRN, Donati F, Bevan DR, Bachman C, Kopelow M, Donen N, Umôn DT, Kemp S, Hartley E, Sikich N, Roy WL, Lerman J, Cooper RM, Yentis SM, Bissonnette B, Halpern L, Roy L, Burrows FA, Fear DW, Hillier S, Sloan M, Crawford M, Blssonnette B, Sikich N, Friedlander M, Sandier AN, Panos L, Winton T, Benureof J, Karski J, Teasdale S, Cruise C, Skala R, Zulys V, Ong D, Chow F, Packota G, Yip R, Bradley J, Arellano R, Sussman G, Sosis M, Braverman B, Sosis M, Ivankovich AD, Manganas M, Lephay A, Fournier T, Kadri N, Ossart M, Sandier AN, Turner KE, Wick V, Wherrett C, Sullivan PJ, Dyck JB, Varvel J, Shafer SL, Fiset P, Balendran P, Meistelman C, Lira E, Sloan M, Nigrovic V, Banoub M, Splinter WM, Roberts DW, Rhine EJ, MacNeill HB, Bonn GE, Clarke WM, Noel LP, Ryan T, Moriarty J, Bouchier-Hayes D, Cunningham AJ, Sandier AN, Baxter AD, Norman P, Samson B, Hull K, Chung F, Mali N, Evans D, Cruise C, Shumka D, Seyone C, Leung PT, Badner NH, Komar WE, Rajasingham M, Farren B, Vaillancourt G, Cournoyer S, Hollmann C, Breen TW, Janzen JA, Crochetiere CT, McMorland GH, Douglas MJ, Kamani AA, Arora SK, Tunstall M, Ross J, Mayer DC, Weeks SK, Norman P, Daley D, Sandier A, Guay J, Gaudreault P, Boulanger A, Tang A, Lortie L, Dupuis C, Backman SB, Bachoo M, Polosa C, Moudgil GC, Frame B, Blajchman HA, Singal DP, Albert JF, Ratcliff A, Law JC, Varvel J, Hung O, Shafer SL, Fiset P, Balendran P, Burgess PM, Doak GJ, Duke PC, Sloan PA, Mather LE, McLean CF, Rutten AJ, Nation RL, Milne RW, Runciman WB, Somoggi AA, Haack C, Shafer SL, Irish CL, Weisleider L, Mazer CD, Bell RS, Dejonckheere M, Levarlet M, d’Hollander A, Taylor RH, Sikich N, Campbell F, McLeod ME, Swartz J, Spahr-Schopfer I, McIntyre BG, Roy WL, Laycock GJA, Mitchell IM, Morton NS, Logan RW, Campbell F, Yentis SM, Fear D, Halpem L, Sloan M, Badgwell JM, Kleinman S, Yentis SM, Britton JT, Hannallah RS, Schafer PO, Norden JM, Splinter WM, Menard EA, Derdamezi JB, Ghurch JG, Britt BA, Radde IC, Sosis M, Kao YJ, Norton RG, Volgyesi GA, Spahr-Schopfer I, Sosis M, Plum M, Sosis M, Smith CE, Pinchak AC, Hancock DE, Owen P, McMeekin J, Hanson S, Cujec B, Feindel CM, Cruz J, Boylen P, Ong D, Murphy JT, Dupuis JY, Nathan HJ, Cattran C, Wynands JE, Murphy JT, Kinley CE, Sulliyan JA, Landymore RW, Robblee JA, Labow R, Buckley DN, Sharpe MD, Guiraudon G, Klein G, Yee R, Black J, Devitt JH, McLellan BA, Dubbin J, Ehrlich LE, Ralley FE, Robbins GR, Symcs JF, Bourke M, Nathan H, Wynands JE. Abstracts. Can J Anaesth 1991. [DOI: 10.1007/bf03008442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hannigan M, Bourke M, Stevens FM, McCarthy CF. Gm typing of Irish coeliac patients and controls does not help locate the "second" coeliac gene. Ir J Med Sci 1991; 160:57-8. [PMID: 1917425 DOI: 10.1007/bf02947649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A two gene model has been proposed to explain the inheritance of coeliac disease (CD). One gene is on chromosome 6 in the MHC complex (HLA associated). It has been suggested the second gene is located on chromosome 14, in or near the region encoding for immunoglobulin heavy chain allotypes (Gm types). In a study of 102 unrelated Irish coeliacs and a group of ethnic controls, we have failed to show an association of CD with any particular Gm type or types. There is no evidence to confirm that a gene on chromosome 14 is implicated in the inheritance of CD.
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Affiliation(s)
- M Hannigan
- University Department of Medicine, University College Hospital, Galway, Ireland
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Bourke M. The new new general practice. West J Med 1990. [DOI: 10.1136/bmj.301.6758.986-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cryan EM, Stevens FM, Skehill R, Bourke M, Grimes H, McCarthy CF. Immunoglobulins in healthy controls: HLA-B8 and sex differences. Tissue Antigens 1985; 26:254-8. [PMID: 3878013 DOI: 10.1111/j.1399-0039.1985.tb00968.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Serum immunoglobulins were measured in one hundred and eighty-four healthy controls. One hundred and fifty-nine of these were also HLA typed. IgG levels did not differ with sex or HLA-B8 status. IgM levels did not differ with HLA-B8 status but were significantly higher in females than males. IgA levels were lower in females than males; they were also lower in HLA-B8 positive compared with HLA-B8 negative individuals; the lowest IgA levels were found in HLA-B8 positive females. The IgA variation may be relevant to the higher incidence of certain disorders among HLA-B8 positive individuals and among females.
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