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Biomedical subjects

D M Nichols

Publications and source records attributed to D M Nichols.

At least 19 recordsLinked to original sources
PubMed2005

Screening for abdominal aortic aneurysm in a geographically isolated area.

BACKGROUND: Screening for abdominal aortic aneurysm has been shown to reduce aneurysm-related mortality, but the applicability of the results to the whole of the UK has been questioned. This study examined screening in a remote and rural area. METHODS: Over 3 years, men aged 65-74 years were offered screening in the community by ultrasonography, usually in general practitioner surgeries. Men with an aneurysm were rescanned at intervals or assessed for surgery. The screening and hospital costs of the programme were calculated. RESULTS: Some 9323 men were offered screening of whom 8355 (89.6 per cent) attended. Uptake was high in all areas. A total of 430 scans (5.1 per cent) were abnormal; 40 men had an aneurysm greater than 55 mm in diameter. Twenty further men had an aorta that enlarged to greater than 55 mm during follow-up. A total of 54 men had elective repair with one death (mortality rate 2 per cent). The cost of screening alone was 16 pound per invitation and the overall cost of the programme, including surgery, was 58 pound per invitation. CONCLUSION: Screening for abdominal aortic aneurysm can be carried out in a remote and rural area with high uptake, acceptable clinical results and at no greater cost than in more densely populated areas.

Aged↗
PubMed2003

Whole-leg duplex mapping for varicose veins: observations on patterns of reflux in recurrent and primary legs, with clinical correlation.

BACKGROUND: the variability of venous reflux patterns complicate the management of venous disease. Our study investigates specific variations in venous anatomy and patterns of reflux in varying clinical situations. METHODS: prospective analysis of 464 legs in 355 patients was performed by complete duplex venous mapping of both primary and recurrent varicose veins. Hand Held Doppler (HHD) and Duplex Ultrasonography (Duplex US) observations in the popliteal fossa were compared in a subgroup of 89 patients with primary varicose veins. Distribution of venous system disease was correlated with clinical severity in a subgroup of 117 affected legs which was representative of the overall study group. RESULTS: sapheno-femoral junction (SFJ) incompetence predominated in both primary and recurrent varicose veins. Only 21% of primary legs and 25% of recurrent legs had sapheno-popliteal junction (SPJ) incompetence. SPJ incompetence was present in only 42% of cases where reflux in the popliteal region on HHD had been demonstrated. A proportion of both primary and recurrent varicose veins had evidence of deep venous incompetence (DVI). Sixty-four percent of primary leg ulcer patients had superficial incompetence alone. In patients with recurrent varicosities and ulceration, 57% had SPJ incompetence, 64% multiple sites and 50% DVI. CONCLUSION: the complex variations of varicose vein anatomy and functional pathology in the lower limb are currently best assessed by complete whole-leg venous duplex mapping.

Adult↗
PubMed2000

Safety of a single duplex scan to exclude deep venous thrombosis.

BACKGROUND: Guidelines advocate that a negative ultrasonographic scan needs to be followed by venography, or a repeat scan after 1 week, to detect potentially missed calf vein thrombosis. This study aimed to evaluate whether anticoagulation can safely be withheld on the basis of a single negative duplex scan in patients presenting with suspected deep venous thrombosis (DVT). METHODS: Duplex scan reports, case notes and questionnaires returned by general practitioners of patients with suspected DVT were analysed retrospectively. The main outcome measure was occurrence of an adverse thromboembolic event, a symptomatic DVT or a pulmonary embolism, within 3 months after a negative duplex scan. RESULTS: Some 537 patients had 706 leg scans performed, the majority because of leg symptoms or to look for indirect evidence of pulmonary embolism. Among 352 patients, who had 429 negative leg scans, four possible adverse events were identified. The rate of adverse outcome was therefore 1.1 per cent per patient and 0.9 per cent per leg. CONCLUSION: Withholding anticoagulation in patients who had a single, complete, negative duplex scan is safe. A repeat scan should be performed if there is ongoing high clinical suspicion and considered in patients in whom the calf veins could not be visualized.

Aged↗
PubMed1999

Haemosuccus pancreaticus due to mucinous cystadenocarcinoma: the significance of recurrent abdominal pain, hyperamylasaemia and a pancreatic cyst in association with recurrent gastrointestinal bleeding.

Haemosuccus pancreaticus is a rare cause of gastrointestinal haemorrhage, and when it presents in otherwise healthy people, can prove difficult to diagnose. The cardinal features are episodic epigastric pain associated with a raised serum amylase and the passage of melaena. Failure to make the connection between recurrent gastrointestinal bleeding and apparently unrelated symptoms attributable to pancreatitis may lead to a significant delay in diagnosis.

Adenocarcinoma, Mucinous↗
PubMed1998

Choledocholithiasis associated with malignant biliary obstruction--significance and management.

Distal bile duct stones and proximal extra-hepatic malignant biliary obstructions may coexist. These stones, probably predating the development of the malignant obstruction but of unknown aetiological significance, were found in seven of 60 patients with proximal tumours (11.6%) at percutaneous biliary drainage. In two of these cases, stones blocked outflow from a supra-ampullary stent. All seven patients also had evidence of gall-bladder stones. Five of the seven patients had cholangiocarcinoma, giving an incidence of duct stones in such patients (n = 27) of 18.5%. In one case, the stones were removed endoscopically, in four, the stones were removed percutaneously and, in the remaining two cases, they were left in situ beside a stent. None of 120 cases with malignant obstruction had stones proximal to the obstruction. Distal common duct stones are associated with proximal malignant biliary duct obstruction, especially with cholangiocarcinoma and coexisting gall-bladder stones. They may interfere with stent function and cause diagnostic confusion at cholangiography.

Aged↗
PubMed1988

Eosinophilic prostatitis simulating invasive prostatic carcinoma: CT appearance.

We report the first description of the computed tomographic findings in a patient with eosinophilic prostatitis, a rare inflammatory disorder of the prostate. The appearances were indistinguishable from advanced invasive prostatic cancer but showed almost complete resolution following corticosteroid therapy.

Adrenal Cortex Hormones↗
PubMed1987

Interhepatic duct: a new biliary anomaly.

True accessory bile ducts occur in only 1% of patients. An accessory bile duct connecting the right and left hepatic ducts at the porta hepatis is described. This anomaly has never been reported previously, and was clinically significant in the presence of partial obstruction of an anomalous right hepatic duct by stones. The embryologic origin of this duct, which we term an "interhepatic duct," is uncertain.

Adolescent↗