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Biomedical subjects

G Phillips

Publications and source records attributed to G Phillips.

At least 55 records · Page 3Linked to original sources
PubMed1998

Candidal urinary tract infection as a cause of pneumaturia.

Colonization of the urinary tract by Candida species occurs particularly in diabetic or immunocompromised patients. We report the cases of two patients presenting with pneumaturia and urinary tract infection who were initially thought to have colovesical fistulae. In both patients a diagnosis of emphysematous pyelonephritis or cystitis due to candidal infection was subsequently made. These cases serve as a reminder of this rare presentation of a not uncommon urinary tract infection.

Aged↗
PubMed1997

Natural history of blood pressure in sickle cell disease: risks for stroke and death associated with relative hypertension in sickle cell anemia.

PURPOSE: Blood pressure in individuals who have sickle cell disease has been reported to be lower than published normal values. We determine whether and to what degree this is true, using data obtained as part of a large natural history study. PATIENTS AND METHODS: Blood pressure was measured annually for 3,317 subjects with sickle cell disease who were 2 years old or older. Values obtained were compared with those reported by the National Health and Nutrition Examination Survey I and II (NHANES I and II). They were further analyzed with respect to age, sex, height, weight, hematologic diagnosis, blood urea nitrogen and creatinine, stroke, and death. RESULTS: Blood pressure was significantly lower in subjects with sickle cell anemia than published norms for age, race, and sex, a difference that increased with age. It correlated with body mass index, hemoglobin, measures of renal function and age, but the strength of the correlation varied among age and sex subgroups. The risk for occlusive stroke increased with systolic but not diastolic pressure. Mortality was related to elevated blood pressure in males (P < 0.05) and to a lesser extent in females (P = 0.10). In subjects with hemoglobin SC disease, blood pressure also deviated from normal but to a lesser degree. CONCLUSION: Blood pressure is generally lower than normal in individuals with sickle cell anemia. Those with high values relative to this population had an increased risk of stroke and death. Blood pressure should be monitored but values obtained must be assessed relative to the lower values expected for patients with this disease. Those with blood pressure values above 140/90 mm Hg should be evaluated and considered for treatment.

Adolescent↗
PubMed1997

Dental students' knowledge and compliance in cross infection control procedures at a UK dental hospital.

OBJECTIVES: To assess the knowledge and clinical practice of dental students in infection control procedures at a UK dental hospital. DESIGN: A questionnaire concerning various aspects of infection control was completed by all clinical dental students under examination conditions. Their actual clinical practice was later observed and certain aspects recorded. SETTING: A UK dental hospital. SUBJECTS: One hundred and eleven dental students from three clinical years completed the questionnaire. Clinical practice for all 3 years was observed in a total of 280 treatment events. METHODS: The questionnaire was marked by two of the authors and observations recorded by another author. MAIN OUTCOME MEASURES: Degree of compliance with recognised policy for infection control. RESULTS: Knowledge of infection control procedures was variable particularly concerning duties usually undertaken by the dental nurse. The suggested high compliance with masks and eye protection was not always apparent in clinical practice, although virtually all students washed their hands prior to donning gloves, which were worn by all students. CONCLUSION: There can be marked differences between what students say they would do and what they actually do in clinical practice. The topic of infection control requires a pro-active approach throughout the course, since results for the final year were not significantly different from the other clinical years. Ways of improving compliance are discussed.

Cross Infection↗
PubMed1996

Psychological adjustment of adults with sickle cell anemia: stability over 20 months, correlates, and predictors.

The stability of psychological adjustment was assessed across three time points spanning a 20-month period with 59 African-American adults with sickle cell anemia. Stable good adjustment was associated with lower levels of daily and illness-related stress, palliative methods of coping with stress, and pain coping strategies characterized by negative thinking/passive adherence. With baseline levels of illness and demographic parameters controlled, baseline levels of daily and illness-related stress made significant independent contributions to adjustment at 20 months follow-up. The findings are discussed in relation to the potential utility of improving methods of coping with stress and pain to enhance the adjustment of patients with sickle cell anemia.

Adaptation, Psychological↗
PubMed1996

The Depth of the Pneumoperitoneum Determines the Safety of Primary Cannula Insertion

We assessed the anterior-to-posterior depth of pneumoperitoneum at various volumes and pressures, and the actual depth when a standard force was applied to the primary cannula in the umbilicus (equivalent to the normal force used). A 5-mm laparoscope was inserted through a suprapubic port and a depth gauge through the 10-mm intraumbilical port. All gas was initially removed from the abdomen, and the depth of the pneumoperitoneum was measured, with and without the standard force applied to the umbilical port, at incremental volumes and pressures up to 25 mm Hg. Our data strongly suggest that a 2- to 3-L pneumoperitoneum is inadequate in most cases, as the anterior abdominal wall will lie directly against bowel or omentum as soon as any force is applied to the umbilical port. The data also suggest that the pneumoperitoneum should be pressure limited and not volume limited. The pressure should be set at 25 mm Hg, as this gives an adequate pneumoperitoneum depth when the primary cannula is inserted, and hence a greater margin of safety.

Journal Article↗
PubMed1996

Impact of an infection consultation service for bacteraemia on clinical management and use of resources.

Since 1993, the infection consultation service for bacteraemia has seen 310 patients in the Medical and Surgical Directorates at Ninewells Hospital and Kings Cross Hospital. A random sample of 100 was audited. Case-notes were incomplete for five patients, leaving 95 fully-audited patients. Clinical outcome measures were death from infection, and readmission within 2 weeks of discharge. Initial treatment was inconsistent with antibiotic policy in 46 patients (48%). Antibiotic treatment was changed in 37 (80%) of these patients: increased in intensity in 19 (41%) and decreased in 18 (39%). Changes were also made in 30 (61%) of the 49 patients whose initial treatment was consistent with sepsis policy-increased in seven (14%) and decreased in 23 (47%). Median daily antibiotic costs were lowered in patients whose initial treatment was consistent with sepsis policy (pounds 10.10 vs. pounds 7.28, p = 0.0274). However, in the other patients, savings were balanced by increases (p = 0.7696). Consultation required one consultant session per week (3.5 h) and the audit required an additional 16 consultant sessions. Seven patients died, but only one death was directly related to infection. Six patients were readmitted to hospital within 2 weeks, in three due to recurrence of infection. Changes to treatment were recommended in the majority of patients, regardless of whether initial treatment complied with the sepsis policy. The service primarily redistributed resources rather than reducing costs. A fully audited service requires considerable consultant time, but we believe such time is well spent.

Anti-Bacterial Agents↗
PubMed1996

Aortic balloon control of a traumatic aortoenteric fistula after damage control laparotomy: a case report.

Aortoenteric fistula is a rare complication of abdominal trauma. We present a case of a patient with multiple gunshot wounds to the abdomen and thorax in whom control of injury required staged operations. An aortoenteric fistula developed, presenting a diagnostic and therapeutic challenge. The operative control of aortic bleeding was by a retroperitoneal approach to the aorta and facilitated by the use of percutaneous aortic balloon catheters. The patient survived to leave hospital. This case highlights a rare trauma complication, the use of "damage control" for the severely injured abdomen and the technique of intra-arterial balloon control of bleeding from inaccessible locations.

Abdominal Injuries↗
PubMed1996

The life of Henry Jeanneret (1802-1886). Pioneer Australian dentist. With an account of his colonial service and scientific contributions in Australia.

Henry Jeanneret was a pioneer Australian dentist, perhaps the first in this country to promote the discipline of dentistry as distinct from medicine and general surgery. This profile describes his early life and training, his emigration to Australia, his clinical practice in Sydney and in Van Diemen's Land, and his contributions to natural history, particularly in the field of botany.

Australia↗
PubMed1996

Variation in postantibiotic effect of clindamycin against clinical isolates of Staphylococcus aureus and implications for dosing of patients with osteomyelitis.

Initial measurements of postantibiotic effect (PAE) were made by a standard laboratory method (exposure to 1 mg of clindamycin per liter for 1 h). The range of PAE for 21 strains of Staphylococcus aureus isolated from osteomyelitis patients was 0.4 to 3.9 h, which markedly exceeded the coefficient of variation for the method (6 to 19%). Exposure of S. aureus to three doses of clindamycin at 8-h intervals had no consistent effect on either PAE or MIC. The PAE was dependent on both concentration and duration of exposure to clindamycin: for example, the PAEs for one strain were 1.7 h after exposure to 1 mg/liter for 1 h, 2.4 h after exposure to 4 mg/liter for 1 h, and 5.9 h after exposure to 4 mg/liter for 3 h. Pharmacokinetic simulations showed that the dose required to maintain free serum clindamycin concentrations above the MIC was 300 mg 6 hourly after oral administration (95% confidence interval, 243 to 301 mg) and 1.2 g 6 hourly (95% confidence interval, 305 to 1,145 mg) after intravenous (i.v.) administration. The duration of PAE would have to be at least 2.4 h to allow an increase in the oral dose interval to 8 h or to allow i.v. administration of 300 mg 6 hourly. Additional PAE experiments were performed with the three strains for which PAEs are the shortest after exposure to 1 mg/liter for 1 h (0.4 to 1.2 h). The PAE for these three strains increased markedly to 4.4 to 6.7 h following exposure to 2 mg/liter for 6 h (to mimic the area under the concentration-time curve from 0 to 6 h after a 300-mg dose). These data suggest that oral clindamycin could be administered at 300 mg 8 hourly in the treatment of S. aureus infection, whereas the i.v. dose interval should be 6 h. These suggestions should be confirmed by performing clinical trials.

Administration, Oral↗
PubMed1996

CRIB (clinical risk index for babies) in relation to nosocomial bacteraemia in very low birthweight or preterm infants.

Positive blood cultures in very low birthweight or preterm infants usually reflect bacteraemia, septicaemia, or failure of asepsis during sampling and lead to increased costs and length of stay. Rates of nosocomial, or hospital acquired, bacteraemia may therefore be important indicators of neonatal unit performance, if comparisons are adjusted for differences in initial risk. In a preliminary study the risk of nosocomial bacteraemia was related to initial clinical risk and illness severity measured by the clinical risk index for babies (CRIB). Nosocomial bacteraemia was defined as clinically suspected infection with culture of bacteria in blood more than 48 hours after birth. One or more episodes of nosocomial bacteraemia were identified retrospectively in 36 of 143 (25%) infants in a regional neonatal unit between 1992 and 1994. Biologically plausible models were developed using regression analysis techniques. After correcting for period at risk, nosocomial bacteraemia was independently associated with gestation at birth and CRIB. Death was independently associated with CRIB, but not with nosocomial bacteraemia. CRIB may contribute, with other explanatory variables, to more comprehensive predictive models of death and nosocomial infection. These may facilitate future risk adjusted comparative studies between groups of neonatal units.

Bacteremia↗
PubMed1995

Complement activation during painful crisis in sickle cell anemia.

Previous studies documented complement activation in sickle cell disease patients and suggested that this contributes to increased risk of infection. We have demonstrated alternative pathway activation initiated by membrane phospholipid changes which occur in sickled erythrocytes. The present studies compared complement activation products in serial samples from sickle cell anemia patients at baseline and during hospitalization for painful crisis to examine the correlation between complement activation and disease activity. Plasma concentrations of Bb, C4d, and C3a were measured as well as C3 bound to erythrocytes. Patients were subdivided into those with continuous pain and those with intermittent painful episodes. In patients with intermittent pain, there was little evidence of complement activation at baseline and increased plasma concentrations of Bb and C3a during painful crisis. Elevated C3a and C4d levels were observed in patients with continuous pain regardless of hospitalization status, suggesting a continuous underlying inflammatory process in these patients.

Acute Disease↗
PubMed1995

Differences between heterosexual, bisexual, and lesbian women in recalled childhood experiences.

Heterosexual, bisexual, and lesbian women recalled the extent to which they had engaged in gender conforming (female-stereotypic) behaviors and gender nonconforming (male-stereotypic) behaviors in childhood. Heterosexual women were more likely to recall having had female-stereotypic experiences as children, whereas lesbian women often recalled a childhood characterized by male-stereotypic experiences. Multiple discriminant function allowed the heterosexual women in the sample to be distinguished from the lesbian women with 80% accuracy in classification of individual cases on the basis of four recollected attributes (imagined self as a male character, wished to become a mother, preference for boys' games, and considered a tomboy as a child). However, some heterosexual women reported much the same childhood behaviors as the majority of lesbian women, and some lesbian women reported much the same childhood behaviors as the majority of heterosexual women. Such diversity raises questions about the nature of the relationship between experiences in childhood and adult sexual orientation.

Adult↗