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Carter LM, Wigston Z, Laws P, Vital E. POS0719 RAPID EFFICACY OF ANIFROLUMAB IN MULTIPLE SUBTYPES OF RECALCITRANT CUTANEOUS LUPUS PARALLELS DISCRETE CHANGES IN TRANSCRIPTOMIC AND CELLULAR BIOMARKERS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundCutaneous lupus eyrthematosus (CLE) is frequently refractory to immunosuppressive therapies including B-cell depletion, but this varies by morphology with the chronic discoid (DLE) subtype being particularly resistant. Local production and response to type-I interferon (IFN-I) is implicated in all subtypes of CLE. Therapeutic blockade of the IFN-I receptor with anifrolumab has direct effects on IFN-I signaling, and subsequent more widespread effects on other immune functions regulated by IFN-I[1].Response to anifrolumab by lesion subtype have not been described, and it is unclear which effects of IFN-blockade are responsible for cutaneous response. We hypothesise that the efficacy of anifrolumab will differ dependent on the relative contribution of direct IFN-I effects vs. the downstream immunostimulatory effects of IFN-I on other immune functions.ObjectivesTo evaluate the effect of anifrolumab on (i) rituximab-refractory CLE; (ii) on DLE; (iii) to compare clinical responses with IFN-specific biomarkers and transcriptomic evaluation of broader immune responses; (iv) to compare early and late immunophenotypic and clinical responses.MethodsSLE patients with active recalcitrant CLE were treated with anifrolumab 300 mg IV every 4 weeks and evaluated using the cutaneous lupus erythematosus disease area and severity index (CLASI) and dermatology life quality index (DLQI). Fluorescence intensity of tetherin (CD317), a cell surface interferon biomarker, was evaluated on major cell subsets by multiparameter flow cytometry of peripheral blood mononuclear cells (PBMCs). Previously validated IFN-Scores-A and B [2], in addition to gene expression scores annotated to inflammation, myeloid lineage and plasmablasts modules [3], were measured in PBMCs using customised Taqman array at baseline, 1 month and 3 months into treatment.Results8 patients (DLE n=5, chillblain / nodular vasculitis n=2, subacute CLE n=1) have enrolled to date. One month clinical and biomarker data are now available for 5. Median number of previously failed standard therapies is 6, including rituximab in 6/8 patients, belimumab in 3/8 and thalidomide in 4/8. Four patients required long-term oral prednisolone >10 mg daily. Median baseline CLASI activity score was 16 and DLQI was 16/30.Rapid clinical responses were evident at 1 month in 4/5 patients, being greatest in magnitude in patients with SCLE and DLE compared with chillblain lesions. Median fall in CLASI activity score at 1 month was 6 points with a median percentage change from baseline of 31%. In all patients, a rapid and marked suppression of IFN-Score-A (mean difference 2.92, p<0.01) and plasmablast tetherin (p=0.01), was evident by 1 month. Small and variable downward trends were observed in inflammation- and IFN-Score-B (p=0.06), myeloid (p=0.27) and plasmablast (p=0.15) -annotated gene expression scores. Major cell population numbers were proportionally unaltered in flow cytometry.ConclusionThese preliminary results suggest that anifrolumab: (i) may be effective in rituximab-resistant CLE, (ii) is effective in DLE; (iii) rapidly suppresses IFN-I response, but with lesser effects on non-IFN immune biomarkers and (iv) early direct effects on IFN-I are associated with rapid clinical response.References[1]Morand et al., Engl J Med 2020; 382:211-221[2]Banchereau et al., Cell 2016;165: 551-65[3]El-Sherbiny et al., Sci. Rep. 2018; 8: 5793Disclosure of InterestsLucy Marie Carter: None declared, Zoe Wigston: None declared, Philip Laws Speakers bureau: AbbVie, Actelion, BMS, Consultant of: Amgen, Celgene, Janssen, Leo, Lilly, Sanofi, Grant/research support from: UCB, Almirall, and Novartis, Edward Vital Consultant of: AstraZeneca, Genentech, Aurinia, Lilly, ILTOO and Modus Therapeutics., Grant/research support from: AstraZeneca and Sandoz
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O’Kane D, Davis L, Ardern-Jones M, Laws P, Shaw L, Cork M, Velangi S, Cooper HL, Hudson R, Smith AB, Rout R. Treatment outcomes of patients with Atopic Dermatitis (AD) treated with dupilumab through the Early Access to Medicines Scheme (EAMS) in the UK. Ulster Med J 2021; 90:70-76. [PMID: 34276083 PMCID: PMC8278937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dupilumab, a monoclonal antibody against interleukin (IL)-4 receptor alpha that inhibits IL-4/IL-13 signalling is indicated in dermatology for the treatment of moderate-to-severe atopic dermatitis (AD) in adult and adolescent patients 12 years and older and severe AD in children 6-11 years, who are candidates for systemic therapy. Dupilumab received Early Access to Medicines Scheme (EAMS) approval for adults in March 2017. OBJECTIVES The purpose of this study was to assess the efficacy outcomes of treatment with dupilumab in EAMS. METHODS A retrospective analysis of adult patients enrolled in the dupilumab EAMS in the UK. Scores were assessed at baseline and follow up, including the Eczema Area and Severity Index (EASI), Investigator's Global Assessment Score (IGA) and Dermatology Life Quality Index (DLQI). RESULTS Data were available for 57 adult patients treated with dupilumab for at least 12 weeks; 73.6% of patients had received prior treatment with 3 or 4 immunosuppressants. Baseline scores for the EASI and DLQI were 27.93 (standard deviation, SD 13.09) and 18.26 (SD 6.18) respectively. AD severity scores showed statistically significant improvement at week 16±4 weeks (p <0.001 for all). The mean change in EASI was 14.13 points with 66.7% and 36.7% achieving a 50% (EASI-50) and 75% (EASI-75) improvement in EASI, respectively at 16+/- 4 weeks. IGA scores improved by at least two categories for 75% patients. DLQI scores decreased by a mean of 9.0 points, with 80% patients demonstrating a MCID 4-point improvement. For 85% patients, clinicians rated the treatment response as being either 'better' (19%) or 'much better' (65%). CONCLUSIONS Dupilumab is associated with a significant and clinically relevant improvements in AD as measured by patient- and physician-reported outcome measures. Importantly, the clinical efficacy, despite the refractory disease of this EAMS cohort, is comparable to that previously reported in clinical trials.
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King N, Elshimy N, Laws P. Maculopapular rash and acute breathlessness in a young man. Clin Exp Dermatol 2020; 46:591-594. [PMID: 33249598 DOI: 10.1111/ced.14496] [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] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- N King
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Elshimy
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Laws
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Abignano G, Laws P, Del Galdo F, Marzo-Ortega H, McGonagle D. Three-dimensional nail imaging by optical coherence tomography: a novel biomarker of response to therapy for nail disease in psoriasis and psoriatic arthritis. Clin Exp Dermatol 2018; 44:462-465. [PMID: 30246363 DOI: 10.1111/ced.13786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- G Abignano
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK.,Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Via Potito Petrone snc, 85100, Potenza, Italy
| | - P Laws
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - F Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - H Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - D McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
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Keszegpál A, Latzko A, Macleod T, Laws P, Goodfield M, Stacey M, Wittmann M. 425 Identification of the skin psoriatic inflammation profile by cytokine analysis from tape stripping. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.445] [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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Lecamwasam K, Mathew B, Gilson D, Burton C, Laws P. Correspondence article regarding CD68 as a marker of CD8+ lymphoid proliferation suggested by Wobseret al. Br J Dermatol 2016; 174:1158-9. [DOI: 10.1111/bjd.14420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - B. Mathew
- Leeds Teaching Hospitals; NHS Trust; Leeds U.K
| | - D. Gilson
- Leeds Teaching Hospitals; NHS Trust; Leeds U.K
| | - C. Burton
- Leeds Teaching Hospitals; NHS Trust; Leeds U.K
| | - P. Laws
- Leeds Teaching Hospitals; NHS Trust; Leeds U.K
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Delaney J, Laws P, Wille-Jørgensen P, Engel A. Inflammatory bowel disease meta-evidence and its challenges: is it time to restructure surgical research? Colorectal Dis 2015; 17:600-11. [PMID: 25546572 DOI: 10.1111/codi.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/12/2014] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to compare the methodological quality and input paper characteristics of systematic reviews and meta-analyses reported in the medical and surgical literature by performing a systematic 'overview of reviews'. Ulcerative colitis (UC) and Crohn's disease (CD) were used as the framework for this comparison as they are relatively common serious conditions, with both medical and surgical options for therapy. METHOD Medline, Embase, CINHAL and the Cochrane Database were searched to November 2013. Eligible papers were systematic reviews or meta-analyses that considered a question of therapy in CD or UC. Two independent reviewers selected the papers, extracted the data and scored their methodology using the AMSTAR scoring system. The papers were categorized into medical therapy (M), surgical therapy (S) or medical and surgical therapy (MS) groups. Following retrieval of the sample of meta-evidence papers, the original input studies used in their creation were identified and a search of Medline, Embase, CINHAL and the Cochrane Database was performed. A team of researchers then examined the collection of papers for bibliographic and financial information. RESULTS Five hundred papers were identified in the meta-evidence search, of which 118 were deemed eligible. There was a difference in the AMSTAR-rated average quality of the papers between the S and M group (S 7.36 vs M 8.75, P = 0.01). On average S papers were published in journals with a lower impact factor (S 3.26, M 5.04, MS 5.30, P < 0.001). S papers also showed more heterogeneity (I(2) ; S 37%, M 24%, MS 10%, P < 0.001). Some 25% of S meta-analyses used data-sets with significant heterogeneity (I(2) > 75%), compared with 8% of M meta-analyses and 3% of the MS meta-analyses. Some 5% of S papers were done on data sets that had I(2) values > 90%. There was no difference in the average number of papers assessed in each group, the average number of patients per meta-paper, the average time covered by the reviews, the average number of papers considered within each meta-analysis, or the average number of patients considered within each meta-analysis. Considering the conclusions of each meta-analysis, S meta-evidence was 50% more likely than M meta-evidence to be unable to make recommendations for practice. A total of 1499 original input papers were identified, of which 283 were used in more than one review. Within the non-repeated papers (n = 1023) the average impact factor within the S group was lower than that of the M and the MS groups (3.720 vs 11.230 vs 7.563, respectively; ANOVAP < 0.001). M papers had higher rates of pharmaceutical sponsorship than S papers (M 56% vs S 1%) and twice the level of government support (M 16% vs S 8%). Of note, 21% of M papers had corporate sponsorship but did not list any conflict of interest. CONCLUSION Compared with M meta-analyses, S meta-analyses in the UC and CD domain are more likely to be of poorer methodological quality, are of a greater degree of heterogeneity and less often offer a positive conclusion. The papers used to generate meta-evidence in M papers have a greater degree of corporate and government sponsorship, and are more likely to come from journals with higher impact factors.
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Affiliation(s)
- J Delaney
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - P Laws
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - P Wille-Jørgensen
- Abdominal Disease Center K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Engel
- Department of Colorectal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Vas A, Laws P, Marsland A, McQuillan O. Acute generalised exanthematous pustulosis induced by Pneumocystis jirovecii pneumonia prophylaxis with dapsone. Int J STD AIDS 2013; 24:745-7. [PMID: 24026795 DOI: 10.1177/0956462413482813] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the case of HIV-1 infected patient presenting to hospital with a severe cutaneous adverse drug reaction shortly after commencing dapsone therapy as Pneumocystis jirovecii pneumonia prophylaxis. To the best of our knowledge, acute generalised exanthematous pustulosis has not been reported as a reaction to dapsone in the setting of HIV.
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Affiliation(s)
- A Vas
- Manchester Centre for Sexual Health and HIV, Manchester Royal Infirmary, Manchester, UK
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Maze M, Laws P, Buckenham T, Pithie A, Gallagher K, Metcalf S, Roake J, Chambers S. Outcomes of Infected Abdominal Aortic Grafts Managed with Antimicrobial Therapy and Graft Retention in an Unselected Cohort. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.02.010] [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]
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Maze M, Laws P, Buckenham T, Pithie A, Gallagher K, Metcalf S, Roake J, Chambers S. Outcomes of Infected Abdominal Aortic Grafts Managed with Antimicrobial Therapy and Graft Retention in an Unselected Cohort. Eur J Vasc Endovasc Surg 2013; 45:373-80. [DOI: 10.1016/j.ejvs.2013.01.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
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Cosgrove J, Nesbitt I, Laws P, Baruch M, Sawdon M, Green J, Fordy K, Kennedy D. Thomas the Tank Engine significantly improves the understanding of oxygen delivery and hypoxaemia. Med Teach 2012; 34:511. [PMID: 22489988 DOI: 10.3109/0142159x.2012.675097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Marr R, Laws P. Visiting hours impact on medical care. Anaesthesia 2011; 66:229-30. [DOI: 10.1111/j.1365-2044.2011.06642.x] [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: 10/18/2022]
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Tracy SK, Tracy MB, Dean J, Laws P, Sullivan E. Spontaneous preterm birth of liveborn infants in women at low risk in Australia over 10 years: a population-based study. BJOG 2007; 114:731-5. [PMID: 17516965 DOI: 10.1111/j.1471-0528.2007.01323.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [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: 11/30/2022]
Abstract
OBJECTIVES To describe a 10-year trend in preterm birth. DESIGN Population-based study. SETTING Australia. POPULATION All women who gave birth during 1994-03. METHODS The proportion of spontaneous preterm births (greater than or equal to 22 weeks of gestation and less than 37 completed weeks of gestation) was calculated by dividing the number of women who had a live spontaneous preterm birth (excluding elective caesarean section and induction of labour) by the total number of women who had a live birth after spontaneous onset of labour (excluding elective caesarean section and induction of labour). This method was repeated for the selected population of women at low risk. MAIN OUTCOME MEASURE Preterm birth rates among the overall population of women; preterm birth among all women with a spontaneous onset of labour; and preterm birth in a selected population of women who were either primiparous or multiparous, non-Indigenous; aged 20-40 years and who gave birth to a live singleton baby after the spontaneous onset of labour. RESULTS Over the 10-year study period, the proportion of all women having a live preterm birth in Australia increased by 12.1% (from 5.9% in 1994 to 6.6% in 2003). Among women with a spontaneous onset of labour, there was an increase of 18.3% (from 5.7 to 6.7%). Among the selected population of low-risk women after the spontaneous onset of labour, the rate increased by 10.7% (from 5.6 to 6.2%) among first time mothers and by 19.2% (4.4-5.2%) among selected multiparous women. CONCLUSIONS Over the 10-year period of 1994-03, the rate of spontaneous preterm birth among low-risk women having a live singleton birth has risen in Australia.
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Affiliation(s)
- S K Tracy
- Australian Institute of Health and Welfare National Perinatal Statistics Unit, University of New South Wales, Randwick, Australia.
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Abstract
INTRODUCTION Hyperhomocysteinaemia has recently been identified as an important risk factor for atherosclerotic vascular disease. Screening for hyperhomocysteinaemia has been recommended, however, the incidence of hyperhomocysteinaemia in vascular patients is not known. AIMS To determine the incidence of hyperhomocysteinaemia in vascular patients, to determine the relation of hyperhomocysteinaemia with folate, vitamin B12 levels and lipid profiles in vascular patients. To examine if there is a relationship between the degree of vascular injury and homocysteine concentration. METHODS New vascular patients at The Queen Elizabeth Hospital were recruited and divided into peripheral, and aneurysmal presentations. Patients demographics were recorded, blood samples were taken for fasting lipid profile, and homocysteine concentration. Samples were also taken for vitamin B12, plasma and red cell folate levels. Sixty age and sex matched controls were included for comparison. RESULTS One hundred and twenty-six patients have been recruited, (95 men and 31 women) with a median age of 68 years (61-74 years). The incidence of elevated homocysteine, and cholesterol levels was 33, 47 and 24%. The levels of vitamin B12 and folate were normal in all patients. Homocysteine was elevated in 27% of claudicants, 50% of patients with rest pain and 53% of patients with an aortic aneurysm. CONCLUSION There is a high rate of hyperhomocysteinaemia in vascular patients with a higher incidence in patients with rest pain. There was also a high incidence of elevated homocysteine levels in patients with an abdominal aortic aneurysm. The rate of growth of these aneurysms is currently under review. Low folate or B12 concentrations is not the cause of raised homocysteine levels.
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Affiliation(s)
- J I Spark
- Department of Surgery, Queen Elizabeth Hospital, University of Adelaide, Woodville 5011, Adelaide, Australia
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Williams DJ, Laws P, Imray C, Lambert AW, Horrocks M. Vascular surgical society of great britain and ireland: near-infrared spectroscopic monitoring of patients undergoing carotid endarterectomy under locoregional anaesthesia. Br J Surg 1999; 86:692. [PMID: 10361316 DOI: 10.1046/j.1365-2168.1999.0692b.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND: The level of cerebral desaturation, which is associated with a change in level of consciousness during carotid endarterectomy, was measured by near-infrared spectroscopy. METHODS: Patients were recruited in two centres over 24 months. Surgery was performed under deep and superficial cervical block using 0.5 per cent bupivacaine, with temazepam as a premedication. Cerebral oxygenation was measured by Critikon 2020 near-infrared spectrophotometers (Johnson and Johnson Medical, Newport, UK). RESULTS: Forty-nine procedures were performed on 45 patients (39 men; age range 52-84 (mean 68) years). Recordings were made from the ipsilateral frontal site in 38 patients, from the ipsilateral temporal site in 23 and bifrontally in eight patients. Monitoring failed in three subjects. Percentage changes in regional cerebral oxygen saturation are detailed below. CONCLUSION: Significantly different levels of cerebral desaturation occur in patients with neurological compromise during carotid endarterectomy compared with those who are unaffected.
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Affiliation(s)
- DJ Williams
- Walsgrave Hospital, Coventry and Royal United Hospital, Bath, UK
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Laws P, Purser N, Williams D. The Stresst'er ergometer. Eur J Vasc Endovasc Surg 1998; 16:450-1. [PMID: 9854563 DOI: 10.1016/s1078-5884(98)80019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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