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Biomedical subjects

C Targett

Publications and source records attributed to C Targett.

6 recordsLinked to original sources

Scaphoid views: a need for standardisation.

AIMS: Several views are needed to visualise the scaphoid. These are routinely called 'scaphoid views'. The authors believe that asking for scaphoid views from the radiology department often leads to a wide variety and number of radiographic views being taken. METHODS: 50 radiographers were asked which and how many views of the scaphoid they would take, in the acute setting and then in the out-patient department. RESULTS: We found a wide variation in the descriptive terms used by radiographers for particular views. There was also little agreement on how many and which radiographic views to take when asked for 'scaphoid views'. CONCLUSIONS: Not only is there complete lack of agreement on what 'scaphoid views' should be, it was also discovered that there was little agreement on the nomenclature of the individual views themselves. Loss of information can result from the wrong views being taken and unnecessary radiation exposure. We recommend five particular views, which together visualise all areas of the scaphoid.

Clinical Competence↗

Knowledge and attitudes about vaginal birth after Caesarean section in Australian hospitals. VBAC Study Group. Vaginal Birth After Caesarean.

A survey of staff attitudes and knowledge about vaginal birth after Caesarean section (VBAC) was undertaken in Australian hospitals. There was a high response rate (67%), and over 900 responses were analysed. Generally, there was a high level of awareness about outcomes and the relative importance of many issues in considering VBAC. Registrars, consultants and midwives differed significantly in some aspects of their knowledge and attitudes to VBAC. There was also a wide range of opinion within each group. Approximately half (53%) of respondents believed patients should be actively encouraged to consider VBAC, whereas 47% felt it should be simply presented as an option.

Attitude of Health Personnel↗

Vaginal birth after Caesarean section: an Australian multicentre study. VBAC Study Group.

Retrospective analysis of medical records and individual case review was undertaken at 11 major obstetric hospitals for a 5 year period from July 1992 to June 1997 to investigate rates of vaginal birth after Caesarean section (VBAC), the occurrences of uterine rupture, and the outcomes for mother and infant following rupture. Total deliveries were 234,015, of which 21,452 or 9.2% were associated with one or more previous Caesarean sections. Within this scar group, 5419 patients or 25.3% were delivered vaginally. There were 62 cases of significant uterine rupture with no maternal deaths. Perinatal mortality with rupture was 25% and serious maternal complications (usually hysterectomy) occurred in 25% of those with uterine rupture. In women attempting vaginal delivery after a previous lower segment Caesarean section, the uterine rupture rate was estimated at 0.3%, with 0.05% experiencing a perinatal death and 0.05% requiring a hysterectomy. Although VBAC rates in Australia remain lower than many overseas reported series, rates are increasing. While rupture continues to be associated with serious adverse outcomes, the incidence of rupture during trial of labour is low and appears to be associated with a better outcome than rupture of an unscarred uterus.

Australia↗

A novel assay for detecting antibodies to cytochrome P4502D6, the molecular target of liver kidney microsomal antibody type 1.

Liver Kidney Microsomal type 1 (LKM1) antibody, the diagnostic marker of autoimmune hepatitis type 2, is also found in a proportion of patients with hepatitis C virus infection (HCV). It is detected conventionally by the subjective immunofluorescence technique. Our aim was to establish a simple and objective enzyme-linked immunosorbent assay (ELISA) that measures antibodies to cytochrome P4502D6 (CYP2D6), the target of LKM1. An indirect ELISA using eukaryotically expressed CYP2D6 was designed. Absorbance values obtained against a reference microsomal preparation were subtracted from those obtained against a microsomal preparation over-expressing CYP2D6, thus removing the non-CYP2D6-specific reaction. Sera from 51 LKM1 positive patients (21 autoimmune hepatitis and 30 with HCV infection), 111 LKM1 negative patients with chronic liver disease (including 20 with HCV infection) and 43 healthy controls were tested. Of 51 patients positive by immunofluorescence, 48 were also positive by ELISA while all the 154 LKM1 negative subjects were also negative by ELISA. There was a high degree of association between IFL and ELISA as demonstrated by a kappa reliability value of 0.96. The absorbance values by ELISA correlated with immunofluorescence LKM1 titres both in autoimmune hepatitis (r = 0.74, p < 0.001) and HCV infection (r = 0.67, p < 0.001). The simple, objective ELISA described has the potential to replace the standard immunofluorescence technique.

Adolescent↗

Caesarean section and trial of scar.

A retrospective study over a 16-year interval at the Mercy Maternity Hospital was made to analyse the contribution made by repeat Caesarean to the overall Caesarean section rate. The practice of trial of scar was examined with reference to the selection of patients, the conduct of labour, and the risks incurred by the mother and infant. The literature has been reviewed. The overall Caesarean section rate was 13.1% with 39.1% being repeat Caesarean sections. The primary rate has increased from 6.6% to 9.3% while the incidence of repeat Caesarean has increased from 2.7% to 6.8%. Of the 4,892 patients with one or more previous Caesarean sections, 1,577 (32.0%) were allowed a trial of scar, 1,197 (75.9%) of whom achieved a vaginal delivery. Thirteen patients sustained a ruptured uterus (0.82%) and 2 of the infants died (perinatal mortality 0.13% due to this complication alone).

Analgesia, Epidural↗