One size fits all? A novel application of the adult Merocel epistaxis pack.
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Adenoidectomy↗
Biomedical subjects
H Griffiths
Publications and source records attributed to H Griffiths.
Hearing threshold assessment post grommet insertion. Is it reliable?
We aimed to investigate whether auditory brainstem response (ABR), assessed immediately after grommet insertion, was an accurate measure of hearing threshold. Ten children were recruited (20 ears). Patients underwent transient evoked otoacoustic emission (TEOAE) and ABR tests before and after grommet insertion under general anaesthetic. A third assessment was conducted at a six-week review, without anaesthetic or sedation. The hearing threshold in dB and the presence of TEOAE were recorded by senior audiologists. The results of each investigation were compared. At review, only 15 ABR and 17 TEOAE tests, of a possible 20, were recorded. Transient evoked otoacoustic emissions were recorded in 30 per cent of ears pre-operatively, 20 per cent of ears post-operatively and 82 per cent of ears at six-week review. The average ABR thresholds were 23.75 dB (range 10-45 dB) pre-operatively, 27.25 (range 15-40 dB) post-operatively and 15 dB (range 5-25 dB) at six-week review. Comparing pre- and post-operative assessment, decreased thresholds were seen in six ears and elevated thresholds in 11. Comparing the six-week review ABR with the post-operative ABR, 13 ears had decreased thresholds, by as much as 20 dB. Thresholds of 35 dB or greater were measured in six ears immediately after grommet insertion (maximum 40 dB). Threshold shifts of 15 dB or greater was observed in seven ears. The intra-subject variation was shown to be significant (p<0.001) when repeated measures analysis of variance was applied. We conclude that there is evidence that ABR can be inaccurate after grommet insertion, overestimating hearing thresholds. We believe that the mechanism by which the error is realised is temporary threshold shift.
Audiometry, Evoked Response↗
A novel application of the adult Merocel nasal pack.
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Adenoidectomy↗
Pre-operative localization of parathyroid adenomas: ultrasonography, sestamibi scintigraphy or both, continuing the debate.
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Adenoma↗
Design and performance of a planar-array MIT system with normal sensor alignment.
In this study the performance of a planar array for magnetic induction tomography (MIT) was investigated and the results of measurements to determine the precision and sensitivity of the sensor were undertaken. A planar-array MIT system utilizing flux-linkage minimization for the primary field has been constructed and evaluated. The system comprises 4 printed excitation coils of 4 turns which were shielded, 8 surface-mount inductors of inductance 10 microH as sensor, mounted such that in principle no primary-field flux threads them, and a calibration coil to produce a strong primary field. The excitation current was multiplexed via relays to drive the excitation and reference coils. The noise values were similar in real and imaginary components in the lower frequencies and the factor to which the primary field could be reduced was greatest in the nearest coil. Methods for determining the true real and imaginary components and for flux-linkage minimization for the primary field for variations in channel sensitivities are described and the results of measurements of the system's noise and drift are given. A SNR of 47 dB was observed at 4 MHz when a 0.3 Sm-1 saline filled tank of dimensions 20 cmx20 cmx10 cm was placed centrally over the array. Finally, images were reconstructed from measurements of saline samples in a free space background, with the samples moved past the array in 21 1 cm steps to emulate mechanical scanning of the array. The image reconstruction characteristics of the planar array in conjunction with the reconstruction technique employed are discussed.
Animals↗
A comparison of sensors for minimizing the primary signal in planar-array magnetic induction tomography.
In magnetic induction tomography reducing the influence of the primary excitation field on the sensors can provide a significant improvement in SNR and/or allow the operating frequency to be reduced. For the purposes of imaging, it would be valuable if all, or a useful subset, of the detection coils could be rendered insensitive to the primary field for any excitation coil activated. Suitable schemes which have been previously suggested include the use of axial gradiometers and coil-orientation methods (Bx sensors). This paper examines the relative performance of each method through computer simulation of the sensitivity profiles produced by a single sensor, and comparison of reconstructed images produced by sensor arrays. A finite-difference model was used to determine the sensitivity profiles obtained with each type of sensor arrangement. The modelled volume was a cuboid of dimensions 50 cmx50 cmx12 cm with a uniform conductivity of 1 S m-1. The excitation coils were of 5 cm diameter and the detection coils of 5 mm diameter. The Bx sensors provided greater sensitivity than the axial gradiometers at all depths, other than on the surface layer of the volume. Images produced using a single-planar array were found to contain distortion which was reduced by the addition of a second array.
Animals↗
The use of ezetimibe in achieving low density lipoprotein lowering goals in clinical practice: position statement of a United Kingdom consensus panel.
There is no doubt that lowering serum cholesterol levels reduces the risk of major coronary events. This evidence has led treatment guidelines to set progressively lower targets for low density lipoprotein cholesterol (LDL-C). However, despite widespread use of statins, substantial numbers of patients do not achieve the LDL-C goals. Using higher doses of statins in an attempt to achieve these targets may increase the risk of serious adverse effects. Furthermore, the use of combination therapy with agents such as bile acid sequestrants, niacin and fibrates has been limited by increased potential for side effects, drug interactions and poor compliance. Ezetimibe, a selective cholesterol transport inhibitor, reduces the intestinal uptake of cholesterol without affecting absorption of triglycerides or fat-soluble vitamins. In clinical studies, ezetimibe 10 mg, in combination with statins or as monotherapy, was well tolerated and reduced LDL-C by 34-53% and 17-18%, respectively. The available evidence for ezetimibe is reviewed. The role of ezetimibe in increasing the proportion of patients attaining LDL-C treatment goals is discussed.
Anticholesteremic Agents↗
Parapharyngeal abscess: diagnosis, complications and management in adults.
Parapharyngeal abscess may cause life-threatening complications. Peritonsillar abscess and tonsillitis may result in parapharyngeal abscess. Since the introduction of antibiotics, the incidence of parapharyngeal abscess secondary to tonsillitis and peritonsillar abscess has decreased dramatically. We present five cases of parapharyngeal abscess resulting from tonsillitis and peritonsillar infection extending to the parapharyngeal space in adult patients. Two were complicated by mediastinitis despite early treatment by wide spectrum antibiotics. We believe that early diagnosis and aggressive antibiotic treatment with early surgical drainage in cases associated with pus collection are the key points in preventing serious and fatal complications. We emphasize the diagnostic role of computerized tomography (CT) scan and the importance of early and proper drainage of these abscesses.
Adult↗
A primary field compensation scheme for planar array magnetic induction tomography.
In biomedical magnetic induction tomography (MIT), measurement precision may be improved by incorporating some form of primary field compensation/cancellation scheme. Schemes which have been described previously include gradiometric approaches and the use of 'back-off' coils. In each of these methods, however, the primary field cancellation was achieved only for a single transmitter/receiver combination. For the purpose of imaging, it would be desirable for a fully electronically scanned MIT system to provide a complete set of measurements, all with the primary field cancelled. A single channel suitable for incorporation into an MIT system with planar-array geometry is described. The transmitter is a 6-turn coil of wire 5 cm in diameter. The receiver is a surface mount inductor, of inductance 10 microH, mounted such that, in principle, no net primary field flux threads it. The results of measurements carried out with the single channel system suggest that the signal due to the primary excitation field can be reduced on average by a factor of 298 by the sensor geometry over the operating frequency range 1-10 MHz. The standard deviation and drift of the signal with the system adjusted for maximum primary field cancellation, expressed as a percentage of the signal when the receiver coil was rotated until its axis of sensitivity lay along the primary field, were 0.0009% and 0.009%, respectively. The filter time constant used was 30 ms.
Artifacts↗
Treating multivessel disease in the era of coated stents: conclusion.
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Coronary Restenosis↗
Normal complement C4 values do not exclude hereditary angioedema.
This report describes a patient with hereditary angioedema (HAE) in whom complement C4 values were consistently normal. There was a family history of HAE, for which the patient had previously been screened, but in view of her normal C4 values she was deemed unaffected. However, at 10 years of age she presented with an eight month history of episodes of swelling affecting her hands and recurrent episodes of abdominal pain over the previous few months. In view of the recent clinical history of swellings and the family history of HAE, C4 and C1 inhibitor (C1inh) were measured. The C4 concentration was found to be within the normal range but the C1inh value was low (0.07 g/litre; normal range, 0.18-0.37). The patient was started on tranexamic acid and at an outpatient review three months later her episodes of swelling were occurring less often and were less severe. Although recent papers have suggested that the diagnosis of HAE can be excluded if complement C4 concentrations are normal, this case highlights the fact that C4 concentrations can be normal in this condition, and it is recommended that both C4 and C1inh concentrations should be measured to exclude HAE.
Angioedema↗
Does asbestos cause laryngeal cancer?
Asbestos is a known carcinogen. Its role in the aetiology of laryngeal cancer has been investigated and debated for the last three decades. Here, we consider much of the published evidence from post-mortem studies, cross-sectional, case-control and cohort studies. We feel that the weight of evidence does not support a causal association for asbestos with laryngeal cancer. The 'positive studies' raise important questions regarding an association; the opportunity may present itself to answer some of these as the incidence of asbestos-related malignancy is increasing in the UK and Europe.
Asbestos↗
The voltage-sensitive release mechanism of excitation contraction coupling in rabbit cardiac muscle is explained by calcium-induced calcium release.
The putative voltage-sensitive release mechanism (VSRM) was investigated in rabbit cardiac myocytes at 37 degrees C with high resistance microelectrodes to minimize intracellular dialysis. When the holding potential was adjusted from -40 to -60 mV, the putative VSRM was expected to operate alongside CICR. Under these conditions however, we did not observe a plateau at positive potentials of the cell shortening versus voltage relationship. The threshold for cell shortening changed by -10 mV, but this resulted from a similar change of the threshold for activation of inward current. Cell shortening under conditions where the putative VSRM was expected to operate was blocked in a dose dependent way by nifedipine and CdCl2 and blocked completely by NiCl2. "Tail contractions" persisted in the presence of nifedipine and CdCl2 but were blocked completely by NiCl2. Block of early outward current by 4-aminopyridine and 4-acetoamido-4'-isothiocyanato-stilbene-2,2'-disulfonic acid (SITS) demonstrated persisting inward current during test depolarizations despite the presence of nifedipine and CdCl2. Inward current did not persist in the presence of NiCl2. A tonic component of cell shortening that was prominent during depolarizations to positive potentials under conditions selective for the putative VSRM was sensitive to rapidly applied changes in superfusate [Na+] and to the outward Na+/Ca2+ exchange current blocking drug KB-R7943. This component of cell shortening was thought to be the result of Na+/Ca2+ exchange-mediated excitation contraction coupling. Cell shortening recorded under conditions selective for the putative VSRM was increased by the enhanced state of phosphorylation induced by isoprenaline (1 microM) and by enhancing sarcoplasmic reticulum Ca2+ content by manipulation of the conditioning steps. Under these conditions, cell shortening at positive test depolarizations was converted from tonic to phasic. We conclude that the putative VSRM is explained by CICR with the Ca2+ "trigger" supplied by unblocked L-type Ca2+ channels and Na+/Ca2+ exchange.
Animals↗
Magnetic induction tomography: phase versus vector-voltmeter measurement techniques.
In magnetic induction tomography (MIT) the in-quadrature component, and hence the phase, of the received signal contains information about the conductivity of the tissue. The quality of imaging will depend on the precision with which phase can be measured. Preliminary studies suggest that a precision of 10 m degrees may be required for a practical biomedical MIT system operating at 10 MHz. This paper describes the results of measurements carried out with a 16-channel, downconverting, 10 MHz, MIT system utilizing two types of data extraction techniques: direct-phase measurement and measurement of the in-phase and in-quadrature components of the signal with a vector voltmeter. The basic precision provided by each technique was 50 m degrees, with thermal drift representing the major limiting factor. Preliminary measurements of average conductivity and permittivity for a human thigh in vivo are given.
Artifacts↗
Hib vaccination in infants born prematurely.
AIMS: To document the immunogenicity and persistence of antibody to polyribosyl-ribitol phosphate (PRP) as well as the clinical protection against invasive Haemophilus influenzae type b (Hib) disease in premature infants immunised at the routine schedule. METHODS: Blood was obtained at 2, 5, 12, and 64 months of age from a cohort of prematurely born infants (<or=32 weeks gestation). Anti-PRP antibody concentrations were compared with those of a control cohort of infants born at full term and vaccinated at the same schedule. Hib vaccine failures occurring between October 1992 and October 2000 were reported by paediatricians through an active, prospective, national survey in the UK and Republic of Ireland. The number of prematurely born children with vaccine failure was compared with the corresponding number born at term. RESULTS: Twenty seven prematurely born infants were followed to 5 years of age. Compared with term infants they had a significantly lower geometric mean concentration of anti-PRP antibody and/or a significantly lower proportion above one or both of the conventional protective antibody concentrations (0.15 and 1.0 micro g/ml) at all ages. A total of 165 cases of invasive Hib disease were identified over eight years of national surveillance. Eighteen were premature (<37 weeks); approximately 12 would be expected. The relative risk of UK premature infants developing disease compared with term infants was 1.5 (95% CI 0.9 to 2.6). CONCLUSIONS: Premature infants develop lower antibody concentrations than term infants following Hib conjugate vaccination. Premature infants may also have an increased risk of clinical vaccine failure, but interpretation is limited by the small number of premature infants developing invasive Hib disease over eight years of national surveillance. Overall, vaccination with Hib conjugate vaccines affords a high level of protection to premature babies.
Antibodies, Bacterial↗
Risk-adjusted comparative audit. Is Possum applicable to head and neck surgery?
Possum (the physiological and operative severity score for the enumeration of mortality) is used in many surgical specialities for comparative audit. We investigated its validity in relation to head and neck surgery by retrospectively scoring 301 operative interventions. We also applied the P-Possum (Portsmouth Possum) equation for mortality. We compared our observed with the predicted outcomes. We introduced two new variables, radiotherapy and previous surgery to the operative site, to test their association with outcome. We found that Possum is valid for morbidity but predicts more accurately for high-risk than for low-risk groups. Neither Possum or P-Possum accurately predicts mortality. Radiotherapy and previous surgery were both significant for the development of postoperative complications (P = 0.002, P = 0.007 respectively) and are worthy of inclusion in a Possum score for head and neck surgery.
Head and Neck Neoplasms↗
Frequency downconversion and phase noise in MIT.
High-frequency (3-30 MHz) operation of MIT systems offers advantages in terms of the larger induced signal amplitudes compared to systems operating in the low- or medium-frequency ranges. Signal distribution at HF, however, presents difficulties, in particular with isolation and phase stability. It is therefore valuable to translate received signals to a lower frequency range through heterodyne downconversion, a process in which relative signal amplitude and phase information is in theory retained. Measurement of signal amplitude and phase is also simplified at lower frequencies. The paper presents details of measurements on a direct phase measurement system utilizing heterodyne downconversion and compares the relative performance of three circuit configurations. The 100-sample average precision of a circuit suitable for use as a receiver within an MIT system was 0.008 degrees for input amplitude -21 dBV. As the input amplitude was reduced from -21 to -72 dBV variation in the measured phase offset was observed, with the offset varying by 1.8 degrees. The precision of the circuit deteriorated with decreasing input amplitude, but was found to provide a 100-sample average precision of <0.022 degrees down to an input amplitude of -60 dBV. The characteristics of phase noise within the system are discussed.
Amplifiers, Electronic↗
Plant responses to water stress.
This Special Issue comprises a series of papers that develops the theme of plant responses to water stress, encompassing recent developments at the molecular level, through responses of photosynthesis and metabolism, to their application in crop selection and yield. The consideration of water deficits is particularly timely, given the huge developments in this area in the past decade. This issue specifically sets out to place molecular and physiological processes and their agronomic applications in an environmental context.
Adaptation, Physiological↗