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C J Durkin

Publications and source records attributed to C J Durkin.

6 recordsLinked to original sources
PubMed2006

Diffusion weighted magnetic resonance imaging for acute stroke: practical and popular.

AIM: To evaluate the feasibility and impact of diffusion weighted magnetic resonance imaging (DW MRI) as the first line neuroimaging of stroke at a district general hospital. METHODS: Prospective audit of all in-patients admitted with clinically suspected acute stroke and referred for imaging over a consecutive 17 week period. The data collected included scan type, time from cerebral event to imaging request, and time from formal radiological request to neuroimaging. Clinicians' (general physicians, neurologists, and radiologists) perceptions were assessed by a questionnaire. RESULTS: 148 patients had neuroimaging for clinically suspected stroke during this period. Eighty one per cent of patients (120 of 148) had DW MRI as first line. Ninety two per cent of these patients had DW MRI within 24 hours of the formal radiological request. Twenty eight patients did not undergo DW MRI because lack of MRI safety, clinical state, unavailability because of maintenance service or lack of trained staff. Clinicians found the introduction of the DW MRI based service a significant improvement on computed tomography, especially for equivocal cases. CONCLUSION: DW based MRI service is both feasible and sustainable in the setting of a district general hospital and most clinicians feel that this is a significant improvement to stroke services.

Acute Disease↗
PubMed1993

The incidence of acute arthritis in stroke patients, and its impact on rehabilitation.

To investigate the occurrence of acute arthritis after stroke, we prospectively studied 111 patients presenting with their first stroke and no history of previous arthritis. Clinical, biochemical and serological assessment was complemented by brain CT scan; appropriate X-rays were taken of any inflamed joints and synovial fluid was collected and analysed. Those with aseptic arthritis were randomly chosen to receive either intra-articular steroids or non-steroidal anti-inflammatory drugs (NSAIDs). Patients with significant renal impairment were excluded. Acute arthritis was observed within 8.34 (median) days, on the paretic side in 19 patients (10 crystal, 4 inflammatory osteoarthritis, 1 septic, 4 unexplained) and on the non-paretic side in 4 patients (1 inflammatory osteoarthritis, 1 septic, 2 unexplained). One patient had pseudogout affecting both sides. Thiazide therapy prior to the stroke was associated with gout in 3 patients. Hospital patients with arthritis had a longer median length of stay than those without (41 vs. 21 days: p = 0.01). Patients receiving intra-articular steroids recovered more rapidly than those treated with NSAIDs (p < 0.05). This prospective study demonstrates the occurrence of acute arthritis in paretic limbs after stroke. Physicians should be aware of this complication, and that administration of intra-articular steroids in aseptic cases speeds rehabilitation and recovery.

Acute Disease↗
PubMed1991

Antibodies to cardiolipin in stroke: association with mortality and functional recovery in patients without systemic lupus erythematosus.

Antibodies to cardiolipin were measured in 100 consecutive patients with first ever stroke, on admission and at three and six months after the acute event. One hundred healthy, age- and sex-matched, British elderly individuals were also screened for antibodies to cardiolipin as a control group. Elevated levels of anticardiolipin antibody (i.e. 5 SD above the laboratory control mean) were present in none of the control group, but in 21 per cent of the patients with stroke. Thirteen of these 21 patients (62 per cent) died within three months, compared to 17 (21.5 per cent) of the seventy-nine patients without elevated levels of anticardiolipin antibodies (p less than 0.001). Six of the eight survivors with persistently elevated anticardiolipin antibodies had significant residual disability following stroke (Barthel score 0-9) compared to 11 of the 62 without (p less than 0.001). Two patients with initially raised anticardiolipin antibodies who became independent at six months showed a progressive decline in the level of these antibodies to normal. The presence of high levels of anticardiolipin antibody did not correlate with other recognized prognostic indices of stroke, except for incontinence. No correlation was noted between levels of antibody to cardiolipin, antinuclear factor, antibody to double-stranded DNA and C-reactive protein, either in the stroke patients or in the elderly control population. Hypertension was significantly more common in the patients with high anticardiolipin antibodies than in the rest of the patients in the stroke population (p = 0.33). There was no correlation between levels of anticardiolipin antibody and age. Anticardiolipin antibody may be considered as an independent prognostic marker for both mortality and clinical outcome after acute stroke.

Aged↗
PubMed1975

Referral letters from general practitioners.

If continuity of care is to be preserved, then the process by which a patient is referred to hospital is important. We have analysed a series of letters of referral from general practitioners with special reference to the diagnoses made and the inclusion of a relevant history.

Communication↗