Biomedical subjects

I R Brand

Publications and source records attributed to I R Brand.

At least 19 recordsLinked to original sources

PubMed1994

Specificity of antenatal ultrasound in the Yorkshire Region: a prospective study of 2261 ultrasound detected anomalies.

OBJECTIVE: To evaluate the specificity of the ultrasound diagnosis of fetal anomalies. Pregnancies which proceeded to termination and ultrasound-diagnosed fetal anomalies which were not offered termination were considered. DESIGN: Prospective, region-wide study over three and a half years. SETTING: Cases were identified through 25 ultrasound departments representing the 15 districts in the Yorkshire Region. SUBJECTS: Pregnant women with an ultrasound-diagnosed fetal anomaly. MAIN OUTCOME MEASURES: Information obtained from the ultrasound report was compared with the outcomes determined by cytogenetics, postmortem or paediatric examination. RESULTS: Of 2261 pregnancies with an ultrasound-diagnosed fetal anomaly 369, (16%) were terminated and 357 (97%) were followed by postmortem examination. Ultrasound findings exactly matched those of the postmortem or were accompanied by additional anomalies in 325 cases (91%). In 32 cases ultrasound findings were not confirmed by postmortem, but in 30 of these the decision to offer termination remained justified because the correct diagnosis was judged equally or more serious. Two (0.5%) were terminated for an anomaly which subsequently proved less severe than predicted on ultrasound. Ultrasound significantly over- or under-diagnosed a major fetal anomaly in 27 of the 1139 (2.4%) cases in which an anomaly was detected, but the pregnancy was not terminated. CONCLUSION: Termination of pregnancy was based on the correct prognosis in over 99.5% of cases. This does not obviate the need for pathological examination of the fetus which changed or refined the diagnosis in 35% of cases.

Abortion, Induced↗

PubMed1993

Early detection of relapse after treatment for metastatic germ cell tumour of the testis: an exercise in medical audit.

The relapse patterns of 29 patients who recurred following treatment for metastatic germ cell tumours of the testis (seminoma n = 7, non-seminomatous germ cell tumour n = 22) have been analysed and the relative effectiveness of clinical follow-up and routine investigations in detecting relapse at an early stage have been examined. The analysis shows that routine estimation of the serum tumour markers human chorionic gonadotrophin and alpha-foetoprotein (HCG and AFP) is the single most important follow-up procedure. This is so, even in patients who were previously marker negative; it was the first indicator of relapse in 55% of the patients. Regular clinical examination and chest radiograph in asymptomatic patients was of little value. Chest radiograph gave the first evidence of relapse in only 2 cases (7%). The optimum frequency for follow-up computed tomographic scanning of the chest and abdomen remains debatable. In this series, it was the first abnormal investigation in 7 patients (24%) and proved to be particularly important in patients who had residual radiological abnormalities at the end of initial therapy. Cost analysis shows that intensive follow-up produces a total expenditure on investigations of approximately 4,500 pounds per relapse detected. Regular computed tomographic scanning is especially demanding on resources and costs approximately 12,880 pounds per relapse detected if the recommended protocol is followed.

Adult↗

PubMed1993

Breast imaging in women under 35 with symptomatic breast disease.

With the increasing utilization of mammography, young women under the age of 35 are being referred for mammographic examination more frequently. A review of the mammograms of 159 consecutive patients aged under 35 was conducted to evaluate the clinical value of the examination in the age group for whom the probability of malignancy is low. 74% of patients referred had no discrete palpable mass and presented predominantly with lumpy or tender breasts, the remaining 24% had a discrete palpable mass. In neither group did radiographic examination beneficially influence clinical management. We propose protocol where no imaging is performed in women under 35 in the absence of a palpable mass unless there is a localized bloody discharge or a strong family history or previous personal history of breast cancer. In patients with a palpable mass, ultrasound should be performed initially to identify simple cysts and if negative only then progressing to mammography.

Adult↗

PubMed1992

Contrast enemas after necrotising enterocolitis: a case for prophylaxis?

During a 4-year period 9 out of 35 patients deteriorated following a contrast enema after necrotising enterocolitis (NEC). Two developed Klebsiella septicaemia with one subsequent death. Following the latter two cases the paediatric surgeons instituted intravenous prophylactic antibiotics (benzyl penicillin, metronidazole, gentamicin) prior to contrast enemas post-NEC. Of the factors examined only the presence a long line in-situ or history of previous perforation demonstrated any increased risk with regard to clinical deterioration post-examination.

Anti-Bacterial Agents↗

PubMed1985

Long-term follow up of trans-sphenoidal hypophysectomy for Cushing's disease.

Fourteen patients with Cushing's disease treated by trans-sphenoidal hypophysectomy between 1962 and 1975 were reviewed in 1983. Complete ablation had been attempted. There were no surgical deaths and one episode of bacterial meningitis. Two patients required a second operation for a cerebrospinal fluid leak. There have been three late deaths from unrelated causes. All patients had a biochemical remission of their Cushing's disease postoperatively and no relapse has been recorded. Most patients need some hormone replacement but residual pituitary function and sella radiography have remained stable. This treatment seems satisfactory and the evidence implies a pituitary aetiology of the syndrome.

Adult↗

PubMed1969