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Biomedical subjects

C Richards

Publications and source records attributed to C Richards.

At least 19 recordsLinked to original sources
PubMed2006

Factors predicting early recurrence after transanal endoscopic microsurgery excision for rectal adenoma.

INTRODUCTION: Transanal endoscopic microsurgery (TEM) is an accepted way of excising rectal adenomas with low morbidity and mortality, avoiding major resectional surgery. However, there are no agreed criteria for surveillance following TEM. The purpose of this study was to identify criteria to guide surveillance programmes, thus reducing the surveillance burden for those patients at low risk of recurrence. PATIENTS AND METHODS: Patients who had undergone TEM for rectal adenomas were identified, and a retrospective review of patient, pathological and histological parameters was performed. RESULTS: Seventy-five (40 male) patients were identified; median age 70 years (39-85). There were seven tubular, 33 tubulo-villous and 35 villous adenomas. All were considered completely excised by the operating surgeon. Forty-seven (62.7%) were reported as being completely excised histologically. There was no significant association between recurrence at 6 months and sex, age, type or position of adenoma, height above the anal verge, or degree of dysplasia. Recurrence rates at six months were 0% for the completely excised adenomas and 21.4% for the incompletely excised ones; this was statistically significant (Pearson chi(2), P < 0.001). In all there were 12 recurrences, 10 in the incompletely excised group at a median follow up of 31 (6-80) months (P < 0.001). In addition, a significant association for large adenomas to recur was noted at median follow up (Armitage Trend test, P = 0.019). CONCLUSIONS: Histological assessment of completeness of excision of rectal adenoma and size of adenoma are important predictors of early recurrence and have potential to guide follow-up strategies after TEM.

Adenoma↗
PubMed2005

Fluids and diuretics for acute ureteric colic.

BACKGROUND: Acute ureteric colic is a common cause of severe and debilitating pain. Theoretically, increasing fluid flow through the affected kidney might expedite stone passage, thereby improving symptoms more quickly. Unfortunately, for interventions such as high volume intravenous or oral fluids and diuretics that are aimed at doing this, the efficacy and safety is uncertain. OBJECTIVES: To look at the benefits and harms of diuretics and high volume (above maintenance) intravenous or oral fluid therapy for treating adult patients presenting with uncomplicated acute ureteric colic. SEARCH STRATEGY: We searched the Cochrane Renal Group's specialised register (July 2004), the Cochrane Central Register of Controlled Trials (CENTRAL - The Cochrane Library, issue 3, 2004), MEDLINE (1966 - July 2004), EMBASE (1980 - July 2004) and handsearched reference lists of nephrology and urology textbooks, review articles, relevant trials, and abstracts from nephrology scientific meetings. We sent letters seeking information about unpublished or incomplete trials to investigators known to be involved in previous trials. SELECTION CRITERIA: All randomised controlled trials (RCTs) and quasi-RCTS (including the first period of randomised cross-over studies) looking at diuretics or high volume intravenous or oral fluids for treating uncomplicated acute ureteric colic in adult patients presenting to the emergency department for the first time during that episode were to be included. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weight mean difference (WMD) for continuous data with 95% confidence intervals (CI). MAIN RESULTS: One trial (60 participants) was identified. This study compared no fluids for six hours versus three litres of IV fluids received over a six hour period. There was no significant difference in pain at six hours (RR 1.06, 95% CI 0.71 to 1.57), surgical stone removal (RR 1.20, 95% CI 0.41 to 3.51) or manipulation by cystoscopy (RR 0.67, 95% CI 0.21 to 2.13). AUTHORS' CONCLUSIONS: Unfortunately, we could find no credible evidence in the literature regarding either of these two treatment modalities. Given their potential positive impact, the role of diuretics and high volume fluid therapy in acute ureteric colic should be examined to determine their safety and efficacy in facilitating stone passage.

Acute Disease↗
PubMed2004

Does Down syndrome affect the outcome of congenital duodenal obstruction?

Congenital duodenal obstruction (DO) has a well-known association with Down syndrome (DS) and other congenital malformations. Previously reported series on DO have not examined the influence of DS on associated congenital malformations and postoperative morbidity and mortality. We report on a retrospective study of all children born with DO over an 11-year period to investigate this. A total of 79 patients with DO were studied: group 1 consisted of 51 (64.6%) children without DS, and group 2 consisted of 28 (35.4%) children with DS. There was no significant difference in mean gestational age and birth weight between groups 1 and 2. A coexisting congenital malformation was found in 68% of patients. Gastrointestinal malformations were the most common in group 1 (71.1%), and cardiac malformations were the most common in group 2 (81.5%). The mean time to reach full intragastric feeds was 12 days, with no significant difference between the two groups ( p=0.383). Seven (8.9%) patients developed a postoperative complication, with no significant difference between both groups ( p=0.853). A total of 11 patients died: six (12%) in group 1 and five (28%) in group 2, with no significant difference between the groups ( p=0.454). DS does not influence the morbidity and mortality of DO but does carry a higher incidence of congenital cardiac abnormalities. Delayed mortality was a result of coexisting congenital cardiac and respiratory disease.

Child, Preschool↗
PubMed2004

Direct access ambulatory BP monitoring--the Edinburgh experience.

The use of electronic measurement of blood pressure and, in particular, ambulatory blood pressure monitoring offers the opportunity to determine which patients with apparent hypertension have truly sustained elevation of their blood pressure levels. Given the high prevalence of hypertension and the even larger number of individuals who appear to be hypertensive but may not be so, it is difficult to deliver ambulatory blood pressure monitoring to all individuals who might benefit from it. In Edinburgh, Scotland, we have piloted a system of direct access ambulatory blood pressure monitoring whereby physicians in primary care can request of the hospital service, an ambulatory monitor on their patient without the patients attending a formal hospital clinic. In the 7 years since the service was first instituted, almost 6,000 monitors have been performed with referrals running at approximately 100 per month in recent times. The present study was set up to assess the impact of the ambulatory monitor result on clinical decision making in primary care. The referral form invited primary care physicians to indicate their planned management if an ambulatory monitor had not been available and we thereafter audited patient records to determine what ultimately happened following the advice given on the basis of the ambulatory monitoring record.A random sample of results was obtained on untreated patients and approximately 500 were analysed. It was clear that if the advice to the primary care physician based upon the ABPM was not to treat, that this was largely followed with some 94% of patients not receiving treatment within 3 months of the monitor. If, however, the advice given was to start treatment, this was less reliably followed and in only 76% of patients treatment was started within 3 months. At the time of the audit this figure had increased to 82%. Primary care physicians had indicated that they would have treated 60% of the individuals referred and in reality only treated 40%. The potential saving in drug costs from the reduction by 20% of those treated would have significant impact on health care budgets.

Blood Pressure Monitoring, Ambulatory↗
PubMed2003

Extracorporeal shock wave therapy for plantar fasciitis. A double blind randomised controlled trial.

BACKGROUND: Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach in the management of a number of tendinopathies. Benefit has been shown in calcific tendinitis of the rotator cuff, but evidence for its use in non-calcific disorders is limited. AIMS: To perform a double blind randomised controlled trial of moderate dose shock wave therapy in plantar fasciitis. METHODS: Adults with plantar fasciitis for at least 3 months were randomised to receive either active treatment (0.12 mJ/mm(2)) or sham therapy, monthly for 3 months. Pain in the day, nocturnal pain and morning start-up pain were assessed at baseline, before each treatment and 1 and 3 months after completion of therapy. RESULTS: Eighty-eight subjects participated and no differences existed between the groups at baseline. At 3 months, 37% of the subjects in the ESWT group and 24% in the sham group showed a positive response (50% improvement from baseline) with respect to pain. Positive responses in night pain occurred in 41% and 31% in the ESWT and sham groups, respectively. Positive responses in start-up pain occurred in 37% and 36% in the ESWT and sham groups, respectively. Both groups showed significant improvement over the course of the study, but no statistically significant difference existed between the groups with respect to the changes were seen in any of the outcome measures over the 6-month period. CONCLUSIONS: There appears to be no treatment effect of moderate dose ESWT in subjects with plantar fasciitis. Efficacy may be highly dependent upon machine types and treatment protocols. Further research is needed to develop evidence based recommendation for the use ESWT in musculoskeletal complaints.

Adult↗
PubMed2002

Extracorporeal shock wave therapy for lateral epicondylitis--a double blind randomised controlled trial.

UNLABELLED: Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach to the treatment of a number of soft tissue complaints. Whilst benefit has been demonstrated in calcific tendinitis, evidence is lacking for benefit in the management of non-calcific rotator cuff disorders. AIMS: To perform a double-blind placebo controlled trial of moderate dose ESWT in chronic lateral epicondylitis. METHODS: Adults with lateral epicondylitis were randomised to receive either active treatment (1500 pulses ESWT at 0.12 mJ/ mm2) or sham therapy, monthly for three months. All were assessed before each treatment and one month after completion of therapy. Outcome measures consisted of visual analogue scores for pain in the day and at night. RESULTS: Seventy-five subjects participated and there were no significant differences between the two groups at baseline. The mean duration of symptoms was 15.9 and 12 months in the ESWT and sham groups, respectively. Both groups showed significant improvements from two months. No significant difference existed between the groups with respect to the degrees of change in pain scores over the study period. In the ESWT group the mean (SD, range) pain score was 73.4 (14.5, 38-99) at baseline and 47.9 (31.4, 3-100) at three months. In the sham group the mean (SD, range) pain score was 67.2 (21.7, 12-100) at baseline and 51.5 (32.5, 3-100) at three months. At three months, 50% improvement from baseline was noted in 35% of the ESWT group and 34% of the sham group with respect to pain. CONCLUSIONS: There appears to be a significant placebo effect of moderate dose ESWT in subjects with lateral epicondylitis but there is no evidence of added benefit of treatment when compared to sham therapy.

Adult↗
PubMed2002

Extracorporeal shock-wave therapy for tendonitis of the rotator cuff. A double-blind, randomised, controlled trial.

We have performed a double-blind placebo-controlled trial of moderate doses of extracorporeal shock-wave therapy (ESWT) for non-calcific tendonitis of the rotator cuff. Adults (74) with chronic tendonitis of the rotator cuff were randomised to receive either active (1500 pulses ESWT at 0.12 mJ/mm2) or sham treatment, monthly for three months. All were assessed before each treatment, and at one and three months after the completion of treatment. The outcome was measured with regard to pain in the shoulder, including a visual analogue score for night pain, and a disability index. There were no significant differences between the two groups before treatment. The mean duration of symptoms in both groups was 23.3 months. Both showed significant and sustained improvements from two months onwards. There was no significant difference between them with respect to change in the Shoulder Pain and Disability Index (SPADI) scores or night pain over the six-month period. A mean (+/-SD; range) change in SPADI of 16.1 +/- 27.2 (0 to 82) in the treatment group and 24.3 +/- 24.8 (-11 to 83) in the sham group was noted at three months. At six months the mean changes were 28.4 +/- 25.9 (-24 to 69) and 30.4 +/- 31.2 (-12 to 88), respectively. Similar results were noted for night pain. We conclude that there is a significant and sustained placebo effect after moderate doses of ESWT in patients with non-calcific tendonitis of the rotator cuff, but there is no evidence of added benefit when compared with sham treatment.

Adult↗
PubMed2001

Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index.

By use of the National Nosocomial Infections Surveillance (NNIS) System's surgical patient surveillance component protocol, the NNIS basic risk index was examined to predict the risk of a surgical site infection (SSI). The NNIS basic SSI risk index is composed of the following criteria: American Society of Anesthesiologists score of 3, 4, or 5; wound class; and duration of surgery. The effect when a laparoscope was used was also determined. Overall, for 34 of the 44 NNIS procedure categories, SSI rates increased significantly (P< .05) with the number of risk factors present. With regard to cholecystectomy and colon surgery, the SSI rate was significantly lower when the procedure was done laparoscopically within each risk index category. With regard to appendectomy and gastric surgery, use of a laparoscope affected SSI rates only when no other risk factors were present. The NNIS basic SSI index is useful for risk adjustment for a wide variety of procedures. For 4 operations, the use of a laparoscope lowered SSI risk, requiring modification of the NNIS basic SSI risk index.

Cross Infection↗
PubMed2001

Posttransplant administration of donor leukocytes induces long-term acceptance of kidney or liver transplants by an activation-associated immune mechanism.

Donor leukocytes play a dual role in rejection and acceptance of transplanted organs. They provide the major stimulus for rejection, and their removal from the transplanted organ prolongs its survival. Paradoxically, administration of donor leukocytes also prolongs allograft survival provided that they are administered 1 wk or more before transplantation. Here we show that administration of donor leukocytes immediately after transplantation induced long-term acceptance of completely MHC-mismatched rat kidney or liver transplants. The majority of long-term recipients of kidney transplants were tolerant of donor-strain skin grafts. Acceptance was associated with early activation of recipient T cells in the spleen, demonstrated by a rapid increase in IL-2 and IFN-gamma at that site followed by an early diffuse infiltrate of activated T cells and apoptosis within the tolerant grafts. In contrast, IL-2 and IFN-gamma mRNA were not increased in the spleens of rejecting animals, and the diffuse infiltrate of activated T cells appeared later but resulted in rapid graft destruction. These results define a mechanism of allograft acceptance induced by donor leukocytes that is associated with activation-induced cell death of recipient T cells. They demonstrate for the first time that posttransplant administration of donor leukocytes leads to organ allograft tolerance across a complete MHC class I plus class II barrier, a finding with direct clinical application.

Animals↗
PubMed2001

Postmenopausal hormone therapy and risk of stroke: The Heart and Estrogen-progestin Replacement Study (HERS).

BACKGROUND: Observational studies have shown that postmenopausal hormone therapy may increase, decrease, or have no effect on the risk of stroke. To date, no clinical trial has examined this question. To investigate the relation between estrogen plus progestin therapy and risk of stroke among postmenopausal women, we analyzed data collected from the Heart & Estrogen-progestin Replacement Study (HERS), a secondary coronary heart disease prevention trial. METHODS AND RESULTS: Postmenopausal women (n=2763) were randomly assigned to take conjugated estrogen plus progestin or placebo. Primary outcomes for these analyses were stroke incidence and stroke death during a mean follow-up of 4.1 years. The number of women with strokes was compared with the number of women without strokes. A total of 149 women (5%) had 1 or more strokes, 85% of which were ischemic, resulting in 26 deaths. Hormone therapy was not significantly associated with risk of nonfatal stroke (relative hazard [RH] 1.18; 95% CI 0.83 to 1.66), fatal stroke (RH 1.61; 95% CI 0.73 to 3.55), or transient ischemic attack (RH 0.90; 95% CI 0.57 to 1.42). Independent predictors of stroke events included increasing age, hypertension, diabetes, current cigarette smoking, and atrial fibrillation. Black women were at increased risk compared with white women, and unexpectedly, body mass index was inversely associated with stroke risk. CONCLUSIONS: Hormone therapy with conjugated equine estrogen and progestin had no significant effect on the risk for stroke among postmenopausal women with coronary disease.

Aged↗
PubMed2001

Adolescents and adjustment to abortion: are minors at greater risk?

The authors tested the Supreme Court's assumption that minors are particularly susceptible to psychological distress following abortion. The responses of 38 minors (age < 18 years) were compared with those of 402 adults, 1 month and 2 years after an elective, 1st-trimester abortion. Minors were relatively less satisfied with their abortion decision and felt less benefit from the abortion than did adults 1 month postabortion, but they did not differ from adults in adjustment 2 years postabortion. Minors were not more depressed than adults at either time period, and their decision satisfaction and perceived benefit at both time periods did not suggest a population at risk. Age group differences in adjustment 1 month postabortion were explained by minors' reduced self-efficacy appraisals for coping, greater use of avoidant coping strategies, and greater perceived parental conflict. These findings challenge the Court's assumption that minors are particularly vulnerable to psychological harm following abortion.

Abortion, Induced↗
PubMed2001

Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for measurement of cytokine and growth factor mRNA expression with fluorogenic probes or SYBR Green I.

Real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) is the method of choice for rapid and reproducible measurements of cytokine or growth factor expression in small samples. Fluorescence detection methods for monitoring real-time PCR include fluorogenic probes labelled with reporter and quencher dyes, such as Taqman probes or Molecular Beacons and the dsDNA-binding dye SYBR Green I. Fluorogenic (Taqman) probes for a range of human and rat cytokines and growth factors were tested for sensitivity and compared with an assay for SYBR Green I quantification using real-time fluorescence monitoring (PE Applied Biosystems Model 7700 sequence detector). SYBR Green I detection involved analysis of the melting temperature of the PCR product and measurement of fluorescence at the optimum temperature. Fluorogenic probes provided sensitive and reproducible detection of targets that ranged from low (<10 copies/reaction) to high (>107 copies/ reaction) expression. SYBR Green I gave reproducible quantification when the target gene was expressed at moderate to high levels (> or =1000 copies/reaction), but did not give consistently reproducible quantification when the target gene was expressed at low levels. Although optimization of melting temperature improved the specificity of SYBR Green I detection, in our hands it did not equal the reproducible sensitivity and specificity of fluorogenic probes. The latter method is the first choice for measurement of low-level gene expression, although SYBR Green I is a simple and reproducible means to quantify genes that are expressed at moderate to high levels.

Animals↗
PubMed2001

Potential role of mental practice using motor imagery in neurologic rehabilitation.

For many patients with damage to the central nervous system (CNS), execution of motor tasks is very difficult, sometimes impossible, even after early participation in an active rehabilitation program. Several investigators have recently proposed that mental practice could be used by these patients as a therapeutic tool to improve their performance of motor functions, yet very little empirical work addresses this issue directly. This article discusses the rationale for investigating mental practice as a means of promoting motor recovery in patients with a neurologic disorder. We first present evidence supporting the existence of a similarity between executed and imagined actions using data from psychophysical, neurophysiologic, and brain imaging studies. This parallel is then extended to the repetition of movements during physical and mental practice of a motor skill. Finally, a new model is proposed to emphasize the key role of motor imagery as an essential process of mental practice, and also to stimulate additional research on this type of training in the rehabilitation of patients with motor impairments of cerebral origin.

Brain↗
PubMed2001

Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999.

The National Nosocomial Infections Surveillance (NNIS) system is the oldest and largest monitoring system for health care-acquired infections in the United States. This report describes both the characteristics of NNIS hospitals compared with those of US hospitals with 100 beds or more and their infection control programs. Overall, NNIS hospitals tend to have more hospital beds than the average for-comparable US hospitals. The majority of NNIS hospitals have affiliations with academic medical centers, and most have substantial intensive care units. Even though infection control professionals in NNIS hospitals spend most of their time in inpatient settings, 40% of their time is also spent in a variety of other settings, including home health, outpatient surgery or clinics, extended care facilities, employee health and quality management, and other clinical or administrative activities. As described in this report, the infrastructure of the NNIS system offers a national resource on which to build improved voluntary patient safety monitoring efforts, as outlined in the recent Institute of Medicine report on medical errors.

Cross Infection↗
PubMed2000

Receptor subunit-specific action of oncostatin M in hepatic cells and its modulation by leukemia inhibitory factor.

The related cytokines, interleukin-6 (IL-6), oncostatin M (OSM), and leukemia inhibitory factor (LIF) direct the formation of specific heteromeric receptor complexes to achieve signaling. Each complex includes the common signal-transducing subunit gp130. OSM and LIF also recruit the signaling competent, but structurally distinct OSMRbeta and LIFRalpha subunits, respectively. To test the hypothesis that the particularly prominent cell regulation by OSM is due to signals contributed by OSMRbeta, we introduced stable expression of human or mouse OSMRbeta in rat hepatoma cells which have endogenous receptors for IL-6 and LIF, but not OSM. Both mouse and human OSM engaged gp130 with their respective OSMRbeta subunits, but only human OSM also acted through LIFR. Signaling by OSMRbeta-containing receptors was characterized by highest activation of STAT5 and ERK, recruitment of the insulin receptor substrate and Jun-N-terminal kinase pathways, and induction of a characteristic pattern of acute phase proteins. Since LIF together with LIFRalpha appear to form a more stable complex with gp130 than OSM with gp130 and OSMRbeta, co-activation of LIFR and OSMR resulted in a predominant LIF-like response. These results suggest that signaling by IL-6 cytokines is not identical, and that a hierarchical order of cytokine receptor action exists in which LIFR ranks as dominant member.

Acute-Phase Proteins↗