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Biomedical subjects

D H Stone

Publications and source records attributed to D H Stone.

At least 55 records · Page 3Linked to original sources
PubMed1997

A multidisciplinary approach to the treatment of Paget-Schroetter syndrome.

To assess the results of thrombolytic therapy and surgical decompression of the thoracic outlet in the management of spontaneous axillary vein thrombosis (AVT), the records of 38 patients at New York University Medical Center (NYUMC) with AVT were reviewed. Excluded from this report were 20 patients who had AVT secondary to an underlying medical condition, a subclavian catheter, or a failed dialysis access graft. Of the 18 remaining patients with no underlying medical condition, all were found to have effort-related axillo-subclavian thrombosis, Paget-Schroetter syndrome. Urokinase was used for thrombolysis in 17 of the 18 patients, (94.4%) with complete lysis in 14 (82.4%). The remaining patient received anticoagulation only following a favorable response to an initial heparin infusion. Of the patients achieving complete thrombolysis, all but one received urokinase within 8 days of the onset of symptoms. Clot lysis revealed axillary vein compression secondary to a thoracic outlet syndrome in 11 patients, and these underwent staged transaxillary thoracic outlet decompression by first rib resection. All 17 patients have been followed for a mean of 21 months, and none receiving lytic therapy have reoccluded. Review of these data confirms earlier reports showing that with early diagnosis, thrombolysis and, if indicated, thoracic outlet decompression, patients with spontaneous AVT can expect excellent clinical results with a good long-term prognosis.

Anticoagulants↗
PubMed1997

A unique approach in the management of vena caval thrombosis in a patient with Klippel-Trénaunay syndrome.

Vena caval thrombosis has posed a surgical therapeutic challenge for many years. Historically, spiral vein grafts and synthetic materials used as prostheses have had variable results. The use of the stent may serve as a more promising alternative when used in the capacity to relieve caval obstruction. A case is reported in which a young woman with Klippel-Trénaunay syndrome has exercise intolerance and associated hypotensive cardiovascular collapse caused by inferior vena caval thrombosis. Recanalization of her inferior vena cava was successfully achieved and subsequently maintained through the placement of two Wallstents across the lesion. Although most venous stenting procedures have thus far been used in the treatment of venous obstruction caused by malignancy, inferior vena cava stenting in this patient with inferior vena caval thrombosis and Klippel-Trénaunay syndrome suggests that venous stenting might offer an alternative therapeutic modality in treating a broader spectrum of occlusive venous disease.

Adult↗
PubMed1996

Screening and the new genetics; a public health perspective on the ethical debate.

Advances in the diagnostic applications of molecular genetics have made possible the identification of recessive carrier states in the population. The debate surrounding screening for cystic fibrosis therefore has a public health significance which transcends that specific disorder. The two most frequently cited objectives of screening for a recessive carrier state are to reduce the prevalence of the disorder and to inform the reproductive choices of individuals and couples at risk. The later aim represents a paradigm shift in the philosophy of screening in that no preventive principle is involved. Instead, information is regarded as worth while in itself, regardless of outcome. The authors argue that the benefits arising from the information generated in the course of genetic carrier screening cannot be presumed merely by asserting a "right to know' ethical imperative, and draw attention to the danger that a combination of technical capability, professional zeal and consumer demand will override currently accepted screening principles. In this event, future efforts to subject screening programmes to rational evaluation could be undermined.

Adult↗
PubMed1996

The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) in the UK: a pilot study.

OBJECTIVES: To assess the feasibility, strengths and weaknesses, and preventive utility of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) in a paediatric setting in the UK. DESIGN: Implementation and operational evaluation of CHIRPP. SETTING: A paediatric accident and emergency department in Glasgow, Scotland, UK. METHODS: CHIRPP forms were used to collect and analyse data on the circumstances, mechanisms, and types of injuries in 2516 children (age range 0-13 years) presenting to the accident and emergency department over the period of 1 April 1993 to 31 January 1995. The strengths and weaknesses of CHIRPP were assessed by direct observation, discussion with staff, operation of the CHIRPP software, and scrutiny of the output. RESULTS: After initial technical problems, CHIRPP ran smoothly. Although parental compliance was high, staff compliance was low, and this resulted in a low capture rate. Tabulations indicated the potential of the system for identifying both hazardous environments and vulnerable population subgroups at whom specific preventive measures can be targeted. Specific proposals for enhancing the efficiency and preventive utility of CHIRPP in this setting were formulated. CONCLUSIONS: CHIRPP offers hospitals, public health departments, and government agencies in the UK a promising tool for planning national, regional, and local injury prevention.

Accident Prevention↗
PubMed1996

Research on injury prevention: time for an international agenda?

OBJECTIVE: To propose an initial agenda for a systematic international research strategy designed to meet the information needs of injury prevention worldwide. CRITERIA FOR INCLUSION AND EXCLUSION OF ARTICLES: The world literature since 1977 was surveyed to obtain an overview of the current research effort on injury epidemiology and prevention. Articles were cited to illustrate the breadth and nature of work published on the topic with special reference to the prevention of home and traffic injuries. CONCLUSIONS: There has been a recent upsurge of interest in injury prevention, although much of the work has been descriptive rather than analytical or evaluative. The implementation of existing knowledge has been patchy. To meet the information needs of effective injury prevention, several elements of an international research agenda are proposed. These include: the achievement of a consensus on terminology, definition, and classification; clarification of the roles of social deprivation, gender, risk taking behaviour, personality, stress, alcohol, drugs, chronic illness, and disability in the aetiology of injury; the development of multi-agency models of good injury prevention practice; the evaluation of counter-measures; the development and evaluation of routine injury surveillance systems.

Global Health↗
PubMed1995

Impact of prenatal screening and diagnosis on the epidemiology of structural congenital anomalies.

OBJECTIVE: To assess the impact of prenatal screening on the birth prevalence of three categories of structural congenital anomaly: abdominal wall defects (omphalocele and gastroschisis), renal agenesis/dysgenesis, and limb reduction defects. SETTING: Glasgow, Scotland, United Kingdom. METHODS: Data on the selected defects were obtained retrospectively from the population based Glasgow Register of Congenital Anomalies for the period 1980-91 inclusive. The register records all clinical or laboratory diagnoses of congenital anomaly in live births, stillbirths, and induced abortions occurring in women resident within the boundaries of the Greater Glasgow Health Board. The secular trends in the proportions of the defects diagnosed prenatally and terminated after screening, and in their prevalence at birth and during pregnancy, were examined. A total of 154,845 births were surveyed: 309 cases were identified in the selected anomaly categories. RESULTS: 83 cases of omphalocele/gastroschisis (5.4/10,000 births), 92 cases of renal agenesis/dysgenesis (5.9/10,000 births), and 134 cases of limb reduction defects (8.7/10,000 births) were found. Marked increases occurred over the study period in the proportions of cases diagnosed prenatally but not in the proportions terminated. The greatest difference between the prevalence at birth and during pregnancy was found for omphalocele. There were no significant secular trends in the prevalence of the selected defects. CONCLUSIONS: Prenatal screening has made a limited epidemiological impact on the prevalence of these defects. It has been moderately (but inconsistently) effective in the avoidance of births of infants with omphalocele/gastroschisis and renal agenesis/dysgenesis but not of limb reduction defects. Future efforts should be directed towards improving the technical aspects of the ultrasonographic detection of fetal abnormalities and exploring in detail, locally, the reasons for the varying pattern of decision making about termination of pregnancy among prospective parents.

Abortion, Induced↗
PubMed1994

Primary care.

Explore the source record for details and available documents.

Humans↗
PubMed1994

Prevalence and first-line treatment of diarrhoeal symptoms in the community.

By systematically sampling patient registers in two socio-economically contrasting Scottish urban general practices, 440 households were selected and contracted by a research health visitor who interviewed a household member in 425 of them (response rate = 97%). Information was obtained on the point and period prevalence of diarrhoeal symptoms in all household members (n = 1,335), and on the knowledge, attitudes and behaviour of the respondents. While the point prevalence was low (under 1% of the household members), around 12% were reported to have experienced symptoms in the three-month period prior to the interview, and these were associated with a small but far from negligible loss of time from school or work. There were no significant seasonal differences in prevalence rates, nor were there significant differences between the two practices. Knowledge about appropriate treatment was high, but there was some confusion about the administration of liquids (especially milk) other than water, and a high level of ignorance about the existence and purpose of oral rehydration solutions. These findings have implications for public education about the initial management of acute diarrhoeal symptoms.

Adolescent↗
PubMed1994

High reported prevalence of congenital anomalies in a Scottish city.

The Glasgow Register of Congenital Anomalies reports the highest birth prevalence of congenital anomalies of all 18 participating centers in the EUROCAT project for the years 1980 to 1988. A high prevalence is found in most defect categories, with Glasgow in the top three places in the EUROCAT "league" in 7 of the 10 categories studied. While the high rate could reflect a high level of ascertainment, we have concluded that there is enough reason to be seriously concerned that the high Glasgow rate is a reflection of risk rather than methodology.

Abnormalities, Multiple↗
PubMed1993

Design a questionnaire.

The design of questionnaires is a craft which has been badly neglected by the medical profession. A questionnaire should be appropriate, intelligible, unambiguous, unbiased, capable of coping with all possible responses, satisfactorily coded, piloted, and ethical. The key steps in designing a questionnaire are to: decide what data you need, select items for inclusion, design the individual questions, compose the wording, design the layout and presentation, think about coding, prepare the first draft and pretest, pilot, and evaluate the form, and perform the survey. Despite the apparently complicated nature of the task, theoretical knowledge is no substitute for practical experience.

Humans↗
PubMed1992

The Chief Scientist reports.... Pattern of decline in prevalence of anencephaly and spina bifida in a high risk area.

The results of three studies spanning the period 1964 to 1989 were aggregated in an attempt to identify secular trends which might contribute to aetiological understanding of anencephaly and spina bifida (ASB). All data related to the prevalence of ASB in a geographically defined population in Glasgow, a known high risk area of neural tube defects. Multiple sources of ascertainment were employed to identify affected cases, whether live births, still births or induced abortions following prenatal diagnosis. The birth prevalence of ASB dropped by 82%, from 5.63 per 1,000 births in 1964-1968 to 1.04 per 1,000 births in 1979-1989, while the pregnancy prevalence (adjusted by including induced abortions) declined by 46%, from 5.63 per 1,000 births in 1964-1968 to 3.02 per 1,000 births in 1979-1989. Thus, prenatal screening contributed just under half of the observed decline in ASB birth prevalence. The pregnancy prevalence appeared to decline throughout the 1970's and early 1980's, and to increase again, temporarily, in the mid-1980s. These data could be interpreted as being broadly consistent with socio-economic hypotheses of ASB aetiology.

Anencephaly↗
PubMed1990

Anatomical distribution of soft tissue sepsis sites in intravenous drug misusers attending an accident and emergency department.

Of 77,686 case records of attendance at an accident and emergency department during 1986, 488 (0.6%) contained documented evidence of intravenous drug misuse (IDM). Clinical examination had revealed signs of soft tissue sepsis in 150 (31%) of these, the commonest sites being the wrist and forearm (31% of lesions), the antecubital fossa (19%), fingers and hand (14%) and thigh and groin (11%). These data highlight the anatomical areas to which medical and nursing staff should pay particular attention when examining patients with a background of IDM. Conversely, the presentation of soft tissue sepsis in these sites should alert clinicians to the possibility of underlying IDM.

Abscess↗