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Search Results: 1 - 10 of 444923 matches for " David M. Coventry "
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Axillary Brachial Plexus Block
Ashish R. Satapathy,David M. Coventry
Anesthesiology Research and Practice , 2011, DOI: 10.1155/2011/173796
Abstract: The axillary approach to brachial plexus blockade provides satisfactory anaesthesia for elbow, forearm, and hand surgery and also provides reliable cutaneous anaesthesia of the inner upper arm including the medial cutaneous nerve of arm and intercostobrachial nerve, areas often missed with other approaches. In addition, the axillary approach remains the safest of the four main options, as it does not risk blockade of the phrenic nerve, nor does it have the potential to cause pneumothorax, making it an ideal option for day case surgery. Historically, single-injection techniques have not provided reliable blockade in the musculocutaneous and radial nerve territories, but success rates have greatly improved with multiple-injection techniques whether using nerve stimulation or ultrasound guidance. Complete, reliable, rapid, and safe blockade of the arm is now achievable, and the paper summarizes the current position with particular reference to ultrasound guidance. 1. Introduction The axillary approach to brachial plexus was first demonstrated in 1884 by William Halsted when he injected cocaine under direct vision [1]. In 1911, G. Hirschel performed the first percutaneous axillary block [2]. It was only after Burnham’s publication in 1959 [3] that this block gained popularity among anaesthetists. Since then, it has become the most used peripheral nerve block for forearm and hand surgery, especially due the low incidence of complications compared to the more proximal approaches to the brachial plexus. 2. The Brachial Plexus in the Axilla [4] The brachial plexus supplies the nerve supply to the upper limb and is formed by the ventral rami of the lower four cervical nerves and the first thoracic nerve. It consists of roots, trunks, divisions, and cords. The roots are arranged between the scalenus anterior and medius muscles, and they combine in the posterior triangle to form three trunks: upper, middle, and lower. On approaching the clavicle, each of the three trunks divides into an anterior and posterior division to supply the flexor and extensor compartments of the arm, respectively. Anterior divisions of the upper and middle trunk unite to form the lateral cord, anterior division of the lower trunk continues as the medial cord, and posterior divisions of all the three trunks assemble to from the posterior cord. The three cords enter the axilla at the apex and are arranged, according to the names, around the second and third parts of the axillary artery. In relation to the first part of the artery, however, the lateral and posterior cords are lateral, and
Minor traumatic brain injuries – what is new?
D Hollander, J Coventry, M Du Trevou
Continuing Medical Education , 2010,
Abstract: No
Maintenance of Fruit Quality in Organically-grown Bananas under Modified Atmosphere Conditions
M.K. Hassan,W.A. Shipton,R.J. Coventry,C.P. Gardiner
Asian Journal of Plant Sciences , 2005,
Abstract: The effects of modified atmosphere packaging at low storage temperature on the quality of organic bananas (cv. Cavendish) were investigated. Polybags, with or without an ethylene scavenger, significantly reduced (p<0.05) the total weight loss of bananas during storage for 25 days and fruit firmness was favoured by packaging. Bags containing a scavenger prevented the peel colour changing beyond the classification ‘greener than yellow’ over 25 days and total soluble solids were lower than in unwrapped fruit. The fruit was not treated with fungicide yet disease levels were relatively low at 25 days. Shelf life extension to 62 days was possible in polybags containing potassium permanganate when held at 14 C. When the scavenger was omitted, storage life was 55 days, yet acceptable taste and other quality were maintained.
Complete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation
Coventry BJ, Ashdown ML
Cancer Management and Research , 2012, DOI: http://dx.doi.org/10.2147/CMAR.S31887
Abstract: mplete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation Review (2817) Total Article Views Authors: Coventry BJ, Ashdown ML Published Date May 2012 Volume 2012:4 Pages 137 - 149 DOI: http://dx.doi.org/10.2147/CMAR.S31887 Received: 17 March 2012 Accepted: 10 April 2012 Published: 28 May 2012 Brendon J Coventry, Martin L Ashdown Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital and Faculty of Medicine, University of Melbourne, Australia Abstract: Over 50 years of cancer therapy history reveals complete clinical responses (CRs) from remarkably divergent forms of therapies (eg, chemotherapy, radiotherapy, surgery, vaccines, autologous cell transfers, cytokines, monoclonal antibodies) for advanced solid malignancies occur with an approximately similar frequency of 5%–10%. This has remained frustratingly almost static. However, CRs usually underpin strong durable 5-year patient survival. How can this apparent paradox be explained?Over some 20 years, realization that (1) chronic inflammation is intricately associated with cancer, and (2) the immune system is delicately balanced between responsiveness and tolerance of cancer, provides a greatly significant insight into ways cancer might be more effectively treated. In this review, divergent aspects from the largely segmented literature and recent conferences are drawn together to provide observations revealing some emerging reasoning, in terms of "final common pathways" of cancer cell damage, immune stimulation, and auto-vaccination events, ultimately leading to cancer cell destruction. Created from this is a unifying overarching concept to explain why multiple approaches to cancer therapy can provide complete responses at almost equivalent rates. This "missing" aspect provides a reasoned explanation for what has, and is being, increasingly reported in the mainstream literature – that inflammatory and immune responses appear intricately associated with, if not causative of, complete responses induced by divergent forms of cancer therapy. Curiously, whether by chemotherapy, radiation, surgery, or other means, therapy-induced cell injury results, leaving inflammation and immune system stimulation as a final common denominator across all of these mechanisms of cancer therapy. This aspect has been somewhat obscured and has been "lost in translation" to date.
The 20th anniversary of interleukin-2 therapy: bimodal role explaining longstanding random induction of complete clinical responses
Coventry BJ, Ashdown ML
Cancer Management and Research , 2012, DOI: http://dx.doi.org/10.2147/CMAR.S33979
Abstract: h anniversary of interleukin-2 therapy: bimodal role explaining longstanding random induction of complete clinical responses Review (2164) Total Article Views Authors: Coventry BJ, Ashdown ML Published Date August 2012 Volume 2012:4 Pages 215 - 221 DOI: http://dx.doi.org/10.2147/CMAR.S33979 Received: 18 May 2012 Accepted: 07 July 2012 Published: 02 August 2012 Brendon J Coventry, Martin L Ashdown Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital and Faculty of Medicine, University of Melbourne, Australia Background: This year marks the twentieth anniversary of the approval by the US Food and Drug Administration of interleukin-2 (IL2) for use in cancer therapy, initially for renal cell carcinoma and later for melanoma. IL2 therapy for cancer has stood the test of time, with continued widespread use in Europe, parts of Asia, and the US. Clinical complete responses are variably reported at 5%–20% for advanced malignant melanoma and renal cell carcinoma, with strong durable responses and sustained long-term 5–10-year survival being typical if complete responses are generated. Methods: The literature was reviewed for the actions and clinical effects of IL2 on subsets of T cells. The influence of IL2 on clinical efficacy was also sought. Results: The review revealed that IL2 is capable of stimulating different populations of T cells in humans to induce either T effector or T regulatory responses. This apparent "functional paradox" has confounded a clear understanding of the mechanisms behind the clinical effects that are observed during and following administration of IL2 therapy. An average complete response rate of around 7% in small and large clinical trials using IL2 for advanced renal cell carcinoma and malignant melanoma has been shown from a recent review of the literature. Conclusion: This review considers the published literature concerning the actions and emerging clinical effects of IL2 therapy, spanning its 20-year period in clinical use. It further details some of the recently described "bimodal" effects of IL2 to explain the apparent functional paradox, and how IL2 might be harnessed to emerge rapidly as a much more effective and predictable clinical agent in the near future.
The 20th anniversary of interleukin-2 therapy: bimodal role explaining longstanding random induction of complete clinical responses
Coventry BJ,Ashdown ML
Cancer Management and Research , 2012,
Abstract: Brendon J Coventry, Martin L AshdownDiscipline of Surgery, University of Adelaide, Royal Adelaide Hospital and Faculty of Medicine, University of Melbourne, AustraliaBackground: This year marks the twentieth anniversary of the approval by the US Food and Drug Administration of interleukin-2 (IL2) for use in cancer therapy, initially for renal cell carcinoma and later for melanoma. IL2 therapy for cancer has stood the test of time, with continued widespread use in Europe, parts of Asia, and the US. Clinical complete responses are variably reported at 5%–20% for advanced malignant melanoma and renal cell carcinoma, with strong durable responses and sustained long-term 5–10-year survival being typical if complete responses are generated.Methods: The literature was reviewed for the actions and clinical effects of IL2 on subsets of T cells. The influence of IL2 on clinical efficacy was also sought.Results: The review revealed that IL2 is capable of stimulating different populations of T cells in humans to induce either T effector or T regulatory responses. This apparent "functional paradox" has confounded a clear understanding of the mechanisms behind the clinical effects that are observed during and following administration of IL2 therapy. An average complete response rate of around 7% in small and large clinical trials using IL2 for advanced renal cell carcinoma and malignant melanoma has been shown from a recent review of the literature.Conclusion: This review considers the published literature concerning the actions and emerging clinical effects of IL2 therapy, spanning its 20-year period in clinical use. It further details some of the recently described "bimodal" effects of IL2 to explain the apparent functional paradox, and how IL2 might be harnessed to emerge rapidly as a much more effective and predictable clinical agent in the near future.Keywords: interleukin-2, cancer therapy, immunotherapy, immune response, translational research, cytokines, regulatory T cells, immune modulation, complete responses, bimodal role
Complete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation
Coventry BJ,Ashdown ML
Cancer Management and Research , 2012,
Abstract: Brendon J Coventry, Martin L AshdownDiscipline of Surgery, University of Adelaide, Royal Adelaide Hospital and Faculty of Medicine, University of Melbourne, AustraliaAbstract: Over 50 years of cancer therapy history reveals complete clinical responses (CRs) from remarkably divergent forms of therapies (eg, chemotherapy, radiotherapy, surgery, vaccines, autologous cell transfers, cytokines, monoclonal antibodies) for advanced solid malignancies occur with an approximately similar frequency of 5%–10%. This has remained frustratingly almost static. However, CRs usually underpin strong durable 5-year patient survival. How can this apparent paradox be explained?Over some 20 years, realization that (1) chronic inflammation is intricately associated with cancer, and (2) the immune system is delicately balanced between responsiveness and tolerance of cancer, provides a greatly significant insight into ways cancer might be more effectively treated. In this review, divergent aspects from the largely segmented literature and recent conferences are drawn together to provide observations revealing some emerging reasoning, in terms of "final common pathways" of cancer cell damage, immune stimulation, and auto-vaccination events, ultimately leading to cancer cell destruction. Created from this is a unifying overarching concept to explain why multiple approaches to cancer therapy can provide complete responses at almost equivalent rates. This "missing" aspect provides a reasoned explanation for what has, and is being, increasingly reported in the mainstream literature – that inflammatory and immune responses appear intricately associated with, if not causative of, complete responses induced by divergent forms of cancer therapy. Curiously, whether by chemotherapy, radiation, surgery, or other means, therapy-induced cell injury results, leaving inflammation and immune system stimulation as a final common denominator across all of these mechanisms of cancer therapy. This aspect has been somewhat obscured and has been "lost in translation" to date.Keywords: chemotherapy, immunotherapy, immune response, common pathways, translational research, oscillation, regulatory T-cells, immune modulation, complete responses
Immuno-Chemotherapy Using Repeated Vaccine Treatment Can Produce Successful Clinical Responses in Advanced Metastatic Melanoma  [PDF]
Brendon Coventry, Peter Hersey, Anne-Marie Halligan, Antonio Michele
Journal of Cancer Therapy (JCT) , 2010, DOI: 10.4236/jct.2010.14032
Abstract: Advanced Stage IV and IIIc melanoma has a dismal survival, with or without, standard chemotherapy. New therapies are required to improve survival and reduce morbidity. Repeated vaccine dosing does not appear to have been explored, so Vaccinia Melanoma Cell Lysate (VMCL) vaccine repetitive therapy was tested, either alone, or combined with chemotherapy. 37 patients (31 Stage IV [M1a(6), b(7), c(18)] and 6 Stage IIIc) were studied using intra-dermal VMCL vaccine therapy. If disease progressed, vaccine was continued with standard chemotherapy (DTIC and/or Fotemustine). Overall survival was assessed and clinical responses were also recorded. From vaccine commencement, median overall follow-up was 10 months. Survivals ranged from 4 to 73 months. Median (mean) overall survival was 10 (23.5) months; overall survival at 1, 2 and 3 years was 40.5%, 21.6% and 10.8% respectively. CR and PR occurred in 18.9% (7) and 18.9% (7) of patients; these were durable for up to 6.1 years in 4 patients. Stable disease was noted in a further 17 patients (45.9%). In 6 patients (16.2%) no response to therapy was apparent. Repeated vaccinations with or without chemotherapy produced strong, durable clinical responses with overall survival > 23 months occurring in nearly 25% of advanced melanoma patients. The overall disease control rate (CR, PR and SD) was 83.7%, including CR in very advanced cases. These results, in a largely unselected population of advanced metastatic melanoma patients, compare very favourably with other regimens, and notably were associated with minimal, if any, toxicity. Further analysis of this approach appears warranted.
Molecular Mimicry, the Hygiene Hypothesis, Stealth Infections and Other Examples of Disconnect between Medical Research and the Practice of Clinical Medicine in Autoimmune Disease  [PDF]
David M. Brady
Open Journal of Rheumatology and Autoimmune Diseases (OJRA) , 2013, DOI: 10.4236/ojra.2013.31007
Abstract:

Autoimmune disorders have been on a steep rise in the industrialized countries over the past several decades and while research has been starting to develop a detailed understanding of pathophysiology and many of the underlying mechanisms, any meaningful incorporation of this information into clinical medicine has been painfully slow. Concepts of molecular mimicry, the hygiene hypothesis, intestinal hyper-permeability (leaky gut syndrome) and aggressive use of predictive antibody testing are explored in this article with examples given on how emerging information on these phenomena may aid the clinician in a new, more proactive, approach to management of these conditions.

Psychosocial risk factors for hospital readmission in COPD patients on early discharge services: a cohort study
Peter A Coventry, Isla Gemmell, Christopher J Todd
BMC Pulmonary Medicine , 2011, DOI: 10.1186/1471-2466-11-49
Abstract: This prospective cohort study included 79 patients with AECOPD cared for by nurse led EDS in the UK, and followed up for 12 months. Data on lung function, medical comorbidities, previous hospital admissions, medications, and sociodemographics were collected at baseline; St George's Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS), and social support were measured at baseline, 3 and 12-months. Exploratory multivariate models were fitted to identify psychosocial factors associated with readmission adjusted for known confounders.26 patients were readmitted within 90 days and 60 patients were readmitted at least once during follow-up. Depression at baseline predicted readmission adjusted for sociodemographics and forced expiratory volume in 1 second (odds ratio 1.30, 95% CI 1.06 to 1.60, p = 0.013). Perceived social support was not significantly associated with risk of readmission. Home ownership was associated with the total number of readmissions (B = 0.46, 95% CI -0.86 to -0.06, p = 0.024). Compared with those not readmitted, readmitted patients had worse SGRQ and HADS scores at 12 months.Depressive symptoms and socioeconomic status, but not perceived social support, predict risk of readmission and readmission frequency for AECOPD in patients cared for by nurse-led EDS. Future work on reducing demand for unscheduled hospital admissions could include the design and evaluation of interventions aimed at optimising the psychosocial care of AECOPD patients managed at home.Readmission following hospital admission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is common, occurring at least once in 60% of patients within 1-year of discharge [1]. Furthermore, rapid readmission within 3-months of discharge affect 30% of patients with AECOPD [2], and underscores the fact that approximately one third of exacerbations are recurrent events occurring within 8 weeks of an initial exacerbation [3].In Europe, early discharge serv
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