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Biomedical subjects

J D Griffiths

Publications and source records attributed to J D Griffiths.

At least 19 recordsLinked to original sources
PubMed2006

A prospective observational study of the effect of night duty on the cognitive function of anaesthetic registrars.

The issue of fatigue in hospital medical staff represents a potential health and safety risk to both staff and patients, and is receiving worldwide interest. We aimed to characterize the cognitive performance of anaesthetic registrars before and after a series of night shifts. We enrolled nine full-time anaesthetic trainees in an Australian adult tertiary-referral hospital. We conducted a cross-over observational study which tested cognitive performance in participants before and after seven consecutive night shifts and compared this with performance before and after seven consecutive day shifts. Cognitive function was measured using a computerized assessment tool. Participants completed a mean of 62.5% of the requested testing (seven participants completed 87%). There was no significant change in performance before or after any day shift, nor at the commencement of each night shift. There was near perfect accuracy in performance in all tests at all times. There was a statistically significant deterioration in speed of performance for detection and identification tasks at the end of night shift as the week progressed. Anaesthetic registrars demonstrate a significant decline in cognitive performance after a series of night shifts.

Anesthesia↗
PubMed2004

Evaluating the performance of the Framingham risk equations in a population with diabetes.

AIMS: The Framingham risk equations are widely used to estimate risk of coronary heart disease (CHD). The purpose of this study was to evaluate the reliability of these equations in predicting CHD risk in people with diabetes and the reliability of using imputed mean HDL-cholesterol values. METHODS: Data describing the baseline characteristics of recognized CHD risk factors for 938 people aged 30-74 years were extracted from the Cardiff Diabetes Database. Data describing CHD events were available for up to 4 years following the baseline year (1996). Several mathematical techniques were used to assess the reliability of predictions provided by the Framingham equations in this population. RESULTS: Thirty-four percent of males and 25% of females who experienced CHD events had a predicted 10-year CHD risk >/= 30%. Seventy-five percent of males and 58% of females had a predicted 10-year CHD risk >/= 20%. Using imputed HDL-cholesterol values, 26% of males and 6% of females who later developed CHD events had a 10-year CHD risk >/= 30%. Using imputed HDL-cholesterol values, the CHD risk predicted by the Framingham equations consistently underestimated the actual risk of CHD events. However, refitting the Framingham risk equations to the Cardiff data resulted in only marginal improvements in discriminatory capabilities. CONCLUSIONS: The Framingham risk equations can be unreliable when applied to the diabetic population, tending to underestimate an individual's probability of progressing to CHD; the equations perform marginally better in women than in men. The use of imputed mean HDL-cholesterol values improved the reliability of the estimates of risk.

Adult↗
PubMed1995

Uveal melanomas in black patients: a case series and comparative review.

Uveal melanomas are rare in black patients. Of a total of 2586 patients with the diagnosis of posterior uveal melanoma who were managed in the Oncology Service at Wills Eye Hospital from 1974 to 1987, 10 patients (0.39%) were black. Data on patient age (mean: 53.9 years), sex (male-to-female ratio: 7:3), and relative frequency of disease between black (0.39% of total cases) and white patients were similar to that of previous reports. The distinguishing characteristics (incidence, risk factors, complications, and prognostic indicators) of uveal melanoma in black versus white patients also were reviewed.

Adult↗
PubMed1991

Nasal catheter use in dacryocystorhinostomy.

A modification of the standard dacryocystorhinostomy (DCR) techniques using a self-retaining nasolacrimal catheter to act as a stent to improve the success rate of nasal ostium patency is described. A series of 21 DCRs performed on 19 patients is presented that includes eight procedures on previously failed DCRs, nine procedures on primary idiopathic obstruction of the nasolacrimal duct, and four procedures where trauma was the etiology. This technique has had no failures except for two procedures that failed because the catheter was too short. This prospective study over 3 years using this technique has resulted in no other cases of closure of the nasal ostium.

Adolescent↗
PubMed1991

Myeloma associated scleromyxedema with extensive involvement of small bowel.

The details of a patient with disseminated scleromyxedema related to multiple myeloma are presented. Investigation demonstrated extensive accumulation of mucopolysaccharides in the skin, bone marrow and the small bowel submucosa. The latter finding is a most unusual manifestation of scleromyxedema and appeared to correlate with the patient's symptoms on presentation.

Aged↗
PubMed1989

High-dose chemotherapy with busulphan and cyclophosphamide and bone-marrow transplantation for drug-sensitive malignancies in adults: a preliminary report.

The technique of high-dose chemotherapy and bone-marrow transplantation takes advantage of any potential dose-response effect in the treatment of cancer and the ability of infused marrow to circumvent severe myelotoxicity. We report our initial experience of 20 high-dose chemotherapy procedures with busulphan and cyclophosphamide as the treatment regimen. Autologous (14 patients), human leukocyte antigen-matched, sibling-allogeneic (five patients) and identical-twin (one patient) transplantations were performed in patients with leukaemias (12 patients), lymphomas (seven patients) or a germ-cell tumour (one patient). One in-hospital and one late death occurred as a result of the toxicity of high-dose chemotherapy. All evaluable patients demonstrated bone-marrow engraftment and became independent of blood transfusions. Five of six patients who were treated in partial remission or relapse obtained a complete remission. Seven patients have relapsed. Eleven patients currently are alive and disease-free and nine patients have returned to their full-time occupations. High-dose chemotherapy can be undertaken with an over-all morbidity that is similar to that which is experienced during the induction chemotherapy of acute leukaemia.

Adolescent↗
PubMed1988

External fixation of complex open humeral fractures.

Seven cases of complex open humeral fractures treated by external fixation are reported. The external fixation allowed the associated injuries to nerves, arteries and soft tissues to be adequately treated. Four cases developed non-union and of these, three cases treated by bone-grafting and plating united, but the one case treated by intramedullary nail without bone-graft did not unite. Frame construction and pin placement are discussed. The recommended plan for treatment of these fractures is initial external fixation until adequate soft tissue healing is achieved and sepsis controlled. Then early bone-grafting and plating is advocated if there is no progressive fracture healing. The problems and advantages encountered in the use of external fixation are also described.

Adult↗
PubMed1987

Symptomatic ossicles of the lateral malleolus in children.

We describe three children with symptoms of damage to the attachment of an anomalous ossific centre of the lower fibular epiphysis. All three were aged 8 to 10 years at the time of the initial injury, had suffered recurrent ankle sprains and had well localised and consistent tenderness precisely at the site of the anomalous ossific centre. All their symptoms were relieved by excision of the ossicle with reconstitution of the fibular collateral ligament. Whilst a separate secondary centre of ossification at the lower fibula is present in 1% of healthy children between the ages of 6 and 12 years, the condition described is extremely uncommon. Excision of the fragment should be reserved for those patients with recalcitrant symptoms and with consistent tenderness precisely at the site of the accessory ossicle.

Ankle Injuries↗
PubMed1987

Oral idarubicin as single-agent treatment of acute nonlymphocytic leukemia in poor-risk patients.

Oral idarubicin was given as single-agent treatment of acute nonlymphocytic leukemia in 18 poor-risk patients. They comprised nine previously untreated elderly patients, age range 69-86, and nine relapsed pretreated patients, age range 41-76. Overall, two patients achieved complete remission (including one with preceding refractory anemia with excess of blasts) and seven achieved partial responses. Dose-limiting toxic effects were diarrhea and sepsis. In this limited study, oral idarubicin at a dose of 20-25 mg/m2/day X 3 was a well-tolerated drug with potent antileukemic effects. The oral formulation deserves more widespread evaluation.

Administration, Oral↗
PubMed1987

Terminal distributions along a 'knight's line' for a stochastic epidemic.

The model under consideration relates to the spread of a disease in a finite population where removal of infectives is allowed to occur. It is equivalent to a restricted random walk over a discrete grid of points interior to a trapezium. We consider an artificial barrier on the grid at which the epidemic ceases. The barrier is a semi-diagonal resembling the path of the knight in chess and allows some simplification of the analysis. In particular, we investigate the probability distribution along this barrier when time is infinite. Recursive relations are obtained for these terminal distributions and are used to develop an exact numerical method for their computation. In certain cases, a slight modification of the binomial distribution provides a good approximation to the actual distribution. A direct recursive method for calculating moments of the distribution is given and we show how the whole distribution may be recovered from these moments.

Disease Outbreaks↗
PubMed1986

Pathological rupture of the spleen in transforming non-Hodgkin's lymphoma.

Two patients with an initial diagnosis of a poorly differentiated lymphocytic lymphoma suffered a pathological rupture of the spleen in association with the histological transformation of the disease to a large cell lymphoma and the development of a leukaemic phase. The value of computerized tomographic scanning of the upper abdomen in confirming the diagnosis of splenic rupture is demonstrated.

Aged↗
PubMed1985

Vincristine neurotoxicity in Charcot-Marie-Tooth syndrome.

The case of a patient with Charcot-Marie-Tooth syndrome and diffuse large-cell lymphoma, in whom a severe generalized weakness developed after the intravenous administration of vincristine (2 mg) during combination chemotherapy, is reported. Spontaneous resolution of the severe weakness occurred when teniposide was substituted for vincristine in the chemotherapy regimen.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Acute changes in iron metabolism following myocardial infarction.

Fifty six patients admitted consecutively to the coronary care unit with ischemic chest pain participated in a controlled prospective study of acute changes in iron metabolism. Following myocardial infarction there were significant reductions of plasma iron by 8.1 mumol/L (P = 0.002), total iron binding capacity by 12.9 mumol/L (P = 0.003), and plasma transferrin by 0.70 g/L (P = 0.007). In contrast, there was a significant elevation of serum ferritin by 218 micrograms/L (P = 0.0005). The magnitude and duration of these acute changes in iron metabolism was greater in patients with higher peak serum creating kinase levels, suggesting that these changes are influenced by the extent of tissue necrosis. Comparison with the control group showed that alteration in dietary iron intake was not a significant factor. The possible mechanisms of these acute changes and their similarity to those observed in the anemia of chronic disease are discussed.

Adult↗
PubMed1984

Torsion of the spleen in the polysplenia syndrome.

A case of splenic torsion is presented in an adult with the polysplenia syndrome. The factors predisposing to splenic torsion are discussed. Splenic torsion may mimic acute appendicitis. The recommended treatment is splenectomy. The polysplenia syndrome may often be undiagnosed when cardiac defects are mild or absent.

Adult↗