PubMed Health⌕ Search

Biomedical subjects

A Allan

Publications and source records attributed to A Allan.

At least 19 recordsLinked to original sources
PubMed1999

Histologic features of lichen sclerosus et atrophicus in a surgical scar.

A 76-year-old woman presented with a 7-mm, hard, pink nodule at the site of an appendectomy scar of more than 70 years' duration. The clinical impression at the time of biopsy was that of a keloid. Surprisingly, light microscopic examination revealed classic histologic features of late-stage lichen sclerosus et atrophicus (LSA) overlying a scar. Elastic tissue stain highlighted the unusual presence of abundant nodules of elastin in the reticular dermis only.

Aged↗
PubMed1998

Confidential inquiry into quality of care before admission to intensive care.

OBJECTIVE: To examine the prevalence, nature, causes, and consequences of suboptimal care before admission to intensive care units, and to suggest possible solutions. DESIGN: Prospective confidential inquiry on the basis of structured interviews and questionnaires. SETTING: A large district general hospital and a teaching hospital. SUBJECTS: A cohort of 100 consecutive adult emergency admissions, 50 in each centre. MAIN OUTCOME MEASURES: Opinions of two external assessors on quality of care especially recognition, investigation, monitoring, and management of abnormalities of airway, breathing, and circulation, and oxygen therapy and monitoring. RESULTS: Assessors agreed that 20 patients were well managed (group 1) and 54 patients received suboptimal care (group 2). Assessors disagreed on quality of management of 26 patients (group 3). The casemix and severity of illness, defined by the acute physiology and chronic health evaluation (APACHE II) score, were similar between centres and the three groups. In groups 1, 2, and 3 intensive care mortalities were 5 (25%), 26 (48%), and 6 (23%) respectively (P=0.04) (group 1 versus group 2, P=0.07). Hospital mortalities were 7 (35%), 30 (56%), and 8 (31%) (P=0.07) and standardised hospital mortality ratios (95% confidence intervals) were 1.23 (0.49 to 2.54), 1.4 (0.94 to 2.0), and 1.26 (0.54 to 2.48) respectively. Admission to intensive care was considered late in 37 (69%) patients in group 2. Overall, a minimum of 4.5% and a maximum of 41% of admissions were considered potentially avoidable. Suboptimal care contributed to morbidity or mortality in most instances. The main causes of suboptimal care were failure of organisation, lack of knowledge, failure to appreciate clinical urgency, lack of supervision, and failure to seek advice. CONCLUSIONS: The management of airway, breathing, and circulation, and oxygen therapy and monitoring in severely ill patients before admission to intensive care units may frequently be suboptimal. Major consequences may include increased morbidity and mortality and requirement for intensive care. Possible solutions include improved teaching, establishment of medical emergency teams, and widespread debate on the structure and process of acute care.

Adult↗
PubMed1997

Tracheal mucormycosis.

Pulmonary mucormycosis is a recognized entity occurring in diabetics and immunocompromised patients. It has a poor prognosis unless early diagnosis is made and appropriate surgical therapy instituted along with appropriate antifungal therapy. We describe here one of few cases of tracheal involvement by mucormycosis. Extensive destruction of the trachea and bibasal pneumonia led to the patient's death.

Aged↗
PubMed1996

Mucosal enzyme activity for butyrate oxidation; no defect in patients with ulcerative colitis.

BACKGROUND: Butyrate is an important energy source for the colon and its metabolism has been reported to be defective in ulcerative colitis. One mechanism for defective butyrate metabolism in patients with ulcerative colitis could be an enzyme deficiency in the beta-oxidation pathway of butyrate. AIMS: This study was undertaken to measure the activity of each enzyme involved in the beta-oxidation pathway of butyrate in colonic epithelium. PATIENTS: Patients with ulcerative colitis (n = 33), Crohn's colitis (n = 10), and control subjects with colorectal cancer or diverticular disease (n = 73) were studied. METHODS: Analysis was carried out using fluorometric and spectrophotometric techniques on homogenised epithelial biopsy specimens. RESULTS: Significantly increased butyryl CoA dehydrogenase activity was found in mucosa from patients with ulcerative colitis (33.2 (28.3, 38.1) mumol/g wet weight/min:mean (95% CI)) compared with activity in mucosa from control patients (24.3 (20.9, 27.7) mumol/g wet weight/min:mean (95% CI)) p < 0.02. No significant increase in activity of the enzymes butyryl-CoA synthetase, crotonase or hydroxybutyryl-CoA dehydrogenase was found in patients with ulcerative colitis. In contrast the mucosal thiolase activity was significantly lower in those patients with quiescent colitis (3.21 (2.61, 3.81) mumol/g wet weight/min:mean (95% CI)) when compared with control mucosa (5.69 (5.09, 6.29) mumol/g wet weight/min:mean (95% CI)) p < 0.001. However, mucosal thiolase activity increases with the age of the donor patient and differences in the age range of the patient groups probably account for this finding. CONCLUSIONS: This study shows no substantial deficiency of enzyme activity in the beta-oxidation pathway of butyrate in the mucosa of patients with ulcerative colitis in histological remission.

Adolescent↗
PubMed1996

Screening for colorectal cancer: a general-practice-based study.

BACKGROUND: A 2-year study was undertaken to determine the best way of setting up faecal occult blood screening for colorectal cancer in a single general practice in north Birmingham, a district with no pre-existing hospital-based screening programme for colorectal cancer. This programme was set up in close collaboration with the Departments of Surgery and Biochemistry at the local Good Hope Hospital Trust. This facilitated joint meetings between the staff of these hospital departments and the practice manager, who was responsible for organization of the study at the Hawthorns Surgery and also supervised the day-to-day running of the programme. Essentially, the study was organized and run by the practice manager and nurse. AIM: The study was undertaken to prepare the way for other general practices in north Birmingham to screen selected populations for colorectal cancer. METHOD: A Haemoccult test kit was posted to patients together with an explanatory letter. The design of the screening programme was similar to the design of the 'screened arm' of the Medical Research Council (MRC) colorectal screening trial in Nottingham. On completion of the programme, questionnaires were posted to 100 responders and 100 non-responders to assess the level of patient acceptability for the screening study. A total of 3509 patients (1599 men and 1910 women) were invited to take part in the screening. RESULTS: The response rate was 55.4%. Thirty-nine patients were referred from the screening study for further investigation. Colonoscopy identified nine adenomas in nine patients, and a further 12 patients were found to have colorectal carcinoma. CONCLUSIONS: The findings from the study suggest that this method could be used as a model for other general practices introducing colorectal screening using Haemoccult.

Aged↗
PubMed1995

Local effects of colorectal cancer are well palliated by endoscopic laser therapy.

We review the results of treating the local effects of 26 cases of inoperable colorectal cancer with Nd:YAG laser. There were 16 men and 10 women of mean age 75, with 17 (65%) rectal, eight (31%) sigmoid and one (4%) ascending colon cancer. They presented with symptoms primarily of obstruction in 12 patients (46%), bleeding in 10 (39%) and diarrhoea in four (15%). Initial therapy to relieve symptoms required a mean of 1.5 (1-3) laser treatments over a mean of 1.5 (1-2) weeks. Twelve patients (46%) had total relief and 12 (46%) had partial relief. Sixteen patients received follow-up maintenance therapy, with laser treatments performed over a mean interval of 7.3 (1-20) weeks. One died at first follow-up treatment; all but two of the others were well maintained by laser treatment alone. Three patients (12%) suffered complications, with two deaths (8%), one due to cardiac failure and the other due to stercoral perforation of the colon. Four patients remained alive after a mean follow-up period of 51 (9-84) months. The mean survival of the others was 5 (0-23) months. Laser palliation for colorectal cancer is efficacious and relatively safe, allows improved quality of survival in 92% of patients after initial treatment, and, alone, can satisfactorily keep patients relatively free of local symptoms in 88% of patients surviving into the follow-up period.

Aged↗
PubMed1995

Rhesus sensitisation.

Explore the source record for details and available documents.

Drug Administration Schedule↗
PubMed1995

Law and psychology: a historical perspective (1).

In this first of a series of three articles, the relationship between law and psychology is discussed from a historical perspective. The article is divided into four sections: First, the early developments are described. Secondly, the use of medical knowledge and experts in Roman law is discussed. Thirdly, attention is devoted to the legal status of the mentally ill during the Middle Ages and how the thirteenth century appears to have been a turning-point in this regard. Lastly, important medicolegal developments during the Renaissance and the replacement of the belief in witchcraft by a more scientific approach are described.

Europe↗
PubMed1995

Expert evidence: the emergence of psychiatry and psychology (2).

In this second of a series of three articles, attention is devoted to the developing role of psychiatrists and psychologists as expert witnesses. As far as psychiatry is concerned, the first recorded use of psychiatric evidence in an English court dates back to the first half of the eighteenth century, but it was not until the nineteenth century that psychiatry was recognized as a field that could contribute significantly to the law. Developments in South Africa regarding forensic psychiatry followed a similar pattern. As for psychology, immediately after its emergence as an autonomous science late in the nineteenth century, it interacted with law. Developments from the stormy early years to the present in the United Kingdom are discussed.

Expert Testimony↗
PubMed1995

Law and psychology in South Africa: development and recommendations (3).

In this last article in a series, the historical development and present status of forensic psychology in South Africa are discussed. First, a critical comparison is made between the legal status of forensic psychologists and that of psychiatrists, and reasons for the present situation are given. Secondly, the reasons why psychologists may soon be expected to play a more important role in the forensic field, are discussed. Lastly, prerequisites for the development of forensic psychology in South Africa are listed: the need for a sound theoretical and clinical knowledge of the chosen field or fields of psychology, knowledge of the relevant legal principles in the specific legal field, the promotion of research and the address of ethical aspects of forensic psychology.

Forecasting↗
PubMed1994

An old head on new shoulders.

A modified stapling technique for anterior resection is described. A pursestring suture is placed in the proximal colon after resection of the specimen; the head of a stapling gun is detached from the stapler and inserted into the proximal bowel and the pursestring suture is tied. A pursestring suture is placed in the rectal stump. A stapling device head from a previous case is autoclaved and then fitted to the stapling device to allow safe insertion per anum: this head is discarded as soon as the distal pursestring is tied. The anastomosis is then completed in the usual way. This technique has been used successfully in twenty-one cases with minimal morbidity and no mortality.

Anastomosis, Surgical↗
PubMed1994

Mucosal glucosamine synthetase activity in inflammatory bowel disease.

Abnormalities in colonic glycoprotein synthesis have been implicated in the pathogenesis of ulcerative colitis and Crohn's disease. Glucosamine synthetase is the rate-limiting step in the biosynthesis of gastrointestinal glycoprotein and has been measured in control subjects (N = 23) and patients with ulcerative colitis (N = 26) or Crohn's disease of the colon (N = 20) classified according to the macroscopic status of the rectum. Glucosamine synthetase activity was relatively constant around the normal colon but lower levels were found in the terminal ileum. In ulcerative colitis, glucosamine synthetase activity was similar to controls (24.0 +/- 1.9) mmol/g wet (wt/hr) irrespective of disease activity (quiescent: N = 13, = 27.3 +/- 1.9; active N = 16, = 26.2 +/- 2.3). Rectal glucosamine synthetase activity was normal in the presence of active Crohn's proctocolitis (29.4 +/- 3.1) but raised in patients with Crohn's colitis and rectal sparing (37.2 +/- 4.9 P < 0.02). Glucosamine synthetase activity was strongly influence by the degree of epithelial preservation.

Colitis, Ulcerative↗
PubMed1994

Faecal diversion for Crohn's colitis: a model to study the role of the faecal stream in the inflammatory process.

The high incidence of clinical remission after faecal diversion for Crohn's colitis suggests the faecal stream may play a part in the inflammatory mechanism. The effect of faecal diversion (n = 22) and restoration of intestinal continuity (n = 10) was assessed in patients with Crohn's colitis and compared with controls. Faecal diversion produced significant improvement in the disease activity index mean (SEM) (before 176 (9); after 114 (9), p < 0.01) and serum albumin concentrations (before 33 (3.0); after 38 (3.0), p < 0.05) in all patients with Crohn's colitis. The crypt cell production rate (CCPR) was maintained after faecal diversion for Crohn's colitis but fell in the control group (before = 3.6 (0.8)), at two (1.4 (0.4), p < 0.02), and six weeks (1.6 (0.4), p < 0.05). Mucosal glucosamine synthetase activity, reflecting glycoprotein synthesis, was significantly lower in patients with Crohn's colitis (analysis of variance p < 0.05) after diversion but was maintained in the control group. Restoration of intestinal continuity failed to produce reciprocal changes. The sustained cellular proliferation and fall in glycoprotein synthesis in Crohn's colitis after faecal diversion may represent the end of an exaggerated protective response and regenerative hyperplasia after exclusion of the faecal stream. This study suggests the faecal stream may participate in the inflammatory process in Crohn's colitis. The underlying mechanism is unknown.

C-Reactive Protein↗