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Biomedical subjects

A Rigby

Publications and source records attributed to A Rigby.

16 recordsLinked to original sources
PubMed2007

The value of in-utero magnetic resonance imaging in ultrasound diagnosed foetal isolated cerebral ventriculomegaly.

AIM: To assess whether magnetic resonance imaging (MRI) is a useful adjunct to ultrasound (US) when imaging cases of foetal isolated cerebral ventriculomegaly. To assess whether, in such cases, ventricular morphology is a useful indicator for the underlying pathology, as has recently been suggested. MATERIALS AND METHODS: A retrospective analysis was undertaken of 30 cases of isolated ventriculomegaly diagnosed using US and referred for in utero MRI. The gestational age of each case was noted and the MRI report. Both ventricles were measured and each case was categorized according to severity and morphology. The MRI report was compared to the final diagnosis. RESULTS: Of the 30 cases evaluated 18 had mild ventriculomegaly (<15 mm; gestational age range 20-31 weeks, mean 22.8, median 22) and 12 had severe ventriculomegaly (>15 mm; gestational age range 21-37 weeks, mean 28, median 28.5). Additional abnormalities were found in 50% of cases overall (44% mild, 58% severe) using MRI. CONCLUSIONS: Using MRI additional abnormalities were identified in 50% of the foetuses. The morphology of the cases did not suggest underlying pathology in this group. In utero MRI is a useful adjunct to US in cases of foetal cerebral ventriculomegaly referred after initial diagnosis using US.

Abnormalities, Multiple↗
PubMed2004

Headache management--are we doing enough? An observational study of patients presenting with headache to the emergency department.

OBJECTIVES: To identify the causes of acute headache presenting to the emergency department (ED), assess the adequacy of history, examination, and investigation, and determine which clinical features are predictive of secondary headache. METHOD: A retrospective study of alert (GCS>or=14) patients presenting with headache, to an ED over a one year period. Patients were followed up for three months. The adequacy of history, examination, and investigation were compared with published standards. Analysis using Bayes's theorem determined which clinical features were predictive of secondary headache. RESULTS: Headache in alert patients accounted for 0.5% (n = 353) of new patient episodes, 81.2% (n = 280) of patients had a primary headache disorder. One patient (0.3%) had an adequate history recorded. No patient had a complete examination recorded. Seventy seven (21.8%) patients underwent computed tomography of the head; 80.5% (n = 62) were normal. Lumbar puncture was performed in 23 (6.5%) cases; 18 (78.3%) were normal. A number of clinical features were found to be predictive of secondary headache. CONCLUSION: Headache is an uncommon symptom in alert patients presenting to the ED. The recorded history, examination, and subsequent investigation do not comply with published standards. A number of predictive features have been identified that may permit the development of a clinical prediction rule to improve the management of this patient group.

Acute Disease↗
PubMed2003

Developing clinically relevant and reproducible symptom-defined populations for cancer diagnostic research in general practice using a community survey.

BACKGROUND: In developing cancer diagnostic studies, there is a particular need for the population of patients with symptoms of possible oncological significance who consult the GP in 'real life' to be comparable with the group of individuals with symptoms constructed as part of a research project. OBJECTIVES: The objective of this study was to seek to assess whether a community-based symptom survey can be harnessed in order to produce clinically relevant and reproducible populations within which studies of more detailed indicants could be undertaken. METHOD: A total of 3629 patients registered with a general practice at Winterton, UK, were sent a questionnaire enquiring about 10 symptoms of possible oncological significance together with their consultation intention in relation to these symptoms. Up to 1 month later, an identical questionnaire was applied to all patients reporting at least one symptom, and more detailed information was obtained by research nurses on each symptom. RESULTS: The overall response rate was 64.4%, and 850 patients reported one or more symptoms. For the majority of symptom reports, there was moderate to substantial agreement between the two applications of the questionnaire. The question on blood in the motions/toilet pan or on the toilet paper demonstrated almost perfect agreement. Slight agreement was found for abdominal pain for longer than 4 weeks and for black/tarry motions. In relation to the reliability of the patient consultation intention, there was substantial/moderate agreement for actions related to the majority of symptoms. For all symptoms, there was also a greater level of agreement for past activity than future intent. CONCLUSION: The results of the study provide some support for a community survey as a mechanism to develop 'clinically relevant' populations for the iatrotropic symptoms rectal bleeding or indigestion/heartburn within which studies of more detailed indicants could be undertaken. There is also consistency with the work of others in relation to the numbers and characteristics of patients within the 'clinically relevant' population.

Aged↗
PubMed2001

Sequencing of protease inhibitor therapy: insights from an analysis of HIV phenotypic resistance in patients failing protease inhibitors.

OBJECTIVE: To characterize the pattern of HIV-1 susceptibility to protease inhibitors in patients failing an initial protease inhibitor-containing regimen. DESIGN: A cross-sectional analysis of antiretroviral susceptibility. SETTING: HIV clinics in six metropolitan areas. PATIENTS: Eighty-eight HIV-infected adults with HIV RNA > 400 copies/ml after > or = 6 months of antiretroviral therapy, including the use of one protease inhibitor for > or = 3 months. MEASUREMENTS: The frequency and magnitude of decreased susceptibility, measured with a phenotypic assay using recombinant constructs, to five protease inhibitors. Decreased susceptibility was defined as > 2.5-fold increase in the 50% inhibitory concentration (IC50) compared with drug sensitive control virus. RESULTS: At study entry, patients were being treated with nelfinavir (63%), indinavir (25%), or another protease inhibitor (11%). HIV isolates from these patients were susceptible (fold change < 2.5) to all five protease inhibitors in 18% of patients and to none in 8%. Isolates from patients receiving nelfinavir were less likely to have reduced susceptibility to other protease inhibitors than isolates from patients treated with indinavir (P < 0.001) or one of the other three agents (P < 0.001), even after adjustment for the duration of prior protease inhibitor use. Reduced susceptibility to saquinavir and amprenavir was observed significantly less frequently than for the other protease inhibitors. CONCLUSION: The frequency of protease inhibitor cross-resistance and the magnitude of changes in susceptibility varied according to the initial protease inhibitor used in the failing treatment regimen. Significantly less protease inhibitor cross-resistance was demonstrated for isolates from patients failing a nelfinavir-containing regimen compared with those from patients receiving other protease inhibitors.

Adult↗
PubMed2001

New-onset palpitations in general practice: assessing the discriminant value of items within the clinical history.

BACKGROUND: Palpitations are non-specific, with less than half of patients experiencing palpitations having a cardiac arrhythmia. Currently it seems that there is little evidence available to assist GPs in discriminating between patients complaining of palpitations who have significant cardiac arrhythmias and those who do not. OBJECTIVES: Our aim was to estimate discriminant functions for specific items of clinical information in relation to the categorization of a patient (aged over 18 years) with a symptom of new-onset palpitations presenting to primary care. METHODS: A network of 62 GPs spread amongst 36 practices agreed to recruit patients with new-onset palpitations over the course of a 9-month study period. Patients consenting to be involved in the study were asked a number of questions, focusing particularly on the medical history, and were requested to complete a Hospital Anxiety and Depression Scale. Each patient was also provided with a RhythmCard cardiac event recorder for up to 2 weeks and was asked to record their heart rhythm if they experienced palpitations. Odds ratios (adjusted for age and sex) were used to compare the clinical information obtained from patients with the final diagnosis. RESULTS: Of the 139 patients with palpitations presenting to GPs, it would appear that males [odds ratio = 2.1 (1.0-4.5)], those with regular palpitations [odds ratio = 2.5 (1.0-5.8)], those experiencing palpitations at work [odds ratio = 3.0 (1.3-7.2)] and those experiencing palpitations affected by sleeping (odds ratio = 3.3 (1.4-7.7)] were more likely to have a cardiac cause for their palpitations. Similar findings were made in an analysis focusing solely on the 81 patients with a RhythmCard result. Furthermore, amongst this group, it is interesting to note that patients with regular palpitations were more than twice as likely to have a 'significant' cardiac arrhythmia as a cause for their palpitations. There were suggestions of dose-response effects between the rate of the palpitation, the duration of the palpitation and the likelihood of it being a 'significant' arrhythmia. CONCLUSIONS: This study provides some information on the characteristics of patients reporting palpitations to GPs who may have 'significant' cardiac arrhythmias. Based on this work, we believe that a larger community-based study would be worthwhile and would provide useful and useable clinical discriminant information for GPs in the settings where they work and amongst the types of patients they encounter.

Adult↗
PubMed1994

Observer variability in measuring elevation and external rotation of the shoulder. Primary Care Rheumatology Society Shoulder Study Group.

The aim of the study was to assess the observer variation between trained primary care physicians in their assessment of two key shoulder movements: elevation and external rotation. Six observers each examined and recorded their visual estimate of the range of movements in six patients assessed in random order. There was good agreement on the range of passive elevation assessed to the start of pain (if present): intraclass correlation coefficient (ICC) = 0.84, and to the point of maximum elevation: ICC = 0.95. There was no evidence of an important systematic bias between observers. By contrast, external rotation was poorly reproducible: ICC = 0.43, with important systematic differences between observers. In the second experiment, six observers simultaneously witnessed a range of movements in a single volunteer subject, and the agreement on their visual estimation of the angles achieved was assessed. There was a marked reduction in the systematic bias in external rotation, but agreement was still poor. Agreement for elevation remained high with a reduction in the small amount of bias observed in the first experiment when variability in both examination and visual assessment had been investigated. We conclude that shoulder elevation is a reliable measurement for use in multicentre studies by trained primary care physicians. By contrast, external rotation is poorly reproducible because of systematic variation in examination technique and random variation in visual assessment.

Female↗
PubMed1991

Media and methods for isolation of aeromonads from fecal specimens. A multilaboratory study.

An international multilaboratory study was conducted to establish the optimal combination of culture media, incubation time and temperature for recovery of aeromonads from stools using blood ampicillin (10 mg/l) agar (BAA), starch ampicillin (10 mg/l) agar (SAA), and cefsulodin irgasan novobiocin agar (CIN) with alkaline peptone water (APW) for enrichment. Optimal recovery of aeromonads (167/186) occurred using BAA (37 degrees C; 24 h) and CIN (25 degrees C; 48 h) with APW (25 degrees C; 24 h) subcultured to BAA (37 degrees C; 24 h) and CIN (25 degrees C; 48 h).

Aeromonas↗
PubMed1991

Penicillin-resistant pneumococci in a Merseyside hospital.

Strains of Streptococcus pneumoniae (N = 915) from clinical specimens were examined for penicillin resistance over a 2-year period. The prevalence of resistance [minimum inhibitory concentration (MIC) greater than 0.1 mg l-1] increased from 1.4 to 2.5% per year during this time. In addition, 83% of penicillin-resistant pneumococci (PRP) showed resistance to chloramphenicol. Most PRP were isolated from uninfected children colonized with the organism, but two out of the three adult cases were clinically infected, one by cross-infection between in-patients. In only two cases was there an association with foreign travel. Three children showed prolonged carriage providing a potential reservoir of infection for other members of the community. The percentage of strains showing high level resistance (MIC greater than 1 mg l-1) increased from 0.7% to 1.9% of all isolates during the 2-year study period. This high prevalence of high level resistance has not been reported previously in the UK and if the trend continues, it will have serious implications for the management of invasive pneumococcal infection, particularly meningitis.

Adult↗
PubMed1988

Age changes in the human female urethra: a morphometric study.

Aging in the human female urethra can contribute towards urinary problems. To our knowledge the effect of age on urethral tissues has not been quantified previously. Histological sections were prepared from 8 regions along the length of the urethra from 26 women between 19 and 88 years old. Using quantitative morphological techniques the relative volume fractions of various tissue components were determined. As age increased there was a decrease in the relative volume of striated muscle and blood vessels, and an increase in the relative volume of connective tissue. There was no change in the smooth muscle components. These age changes in the human female urethra may lead to impairment of urethral function.

Adult↗
PubMed1988

Recent trends in the prevalence of byssinotic symptoms in the Lancashire textile industry.

A respiratory symptoms questionnaire was completed for 4656 volunteers employed in 31 textile factories engaged in spinning or weaving manmade fibre or cotton of various qualities. Sets of airborne dust and bacteria samples were collected in workzones and personal breathing zones in the workrooms where the volunteers were employed. A total of 182 people indicated experiencing byssinotic symptoms, mainly in opening and carding rooms or in spinning and winding rooms where medium to coarse cotton was being processed. This represents a significant decline in the prevalence of byssinotic symptoms over the years, due possibly to lower concentrations of airborne contaminants, especially of bacteria, as cleaner raw materials are being used. According to a multiple, logistic regression model, the prevalence of byssinotic symptoms was found to be statistically significantly related to years worked in the cotton industry, exposure to dust, quality of cotton used, workroom of employment, ethnic origin, and smoking habits. Symptoms of chronic bronchitis were found to be significantly related to smoking habit and to factors connected with occupation, such as exposure to dust, workroom, and the quality of fibre processed.

Byssinosis↗