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Biomedical subjects

J Royle

Publications and source records attributed to J Royle.

At least 19 recordsLinked to original sources
PubMed2005

The diagnosis and management of Kawasaki disease.

Kawasaki disease (KD) is a systemic vasculitis of childhood with a predilection for the coronary arteries. It is the predominant cause of paediatric acquired heart disease in developed countries. The aetiology of KD remains unknown and consequently there is no diagnostic test. The diagnosis is made using a constellation of clinical criteria that in isolation have poor sensitivity and specificity. Early treatment prevents overt coronary artery damage in the majority of children. The long-term effects of childhood KD on later cardiovascular health remain unknown. A recent study showed that treatment of KD in Australia is suboptimal, with late diagnosis occurring in approximately half of the cases and an unacceptably high incidence of acute cardiac involvement. These guidelines highlight the difficulties in the diagnosis of KD and offer some clues that may assist early recognition of this important paediatric disease. They also detail current treatment recommendations and the evidence on which they are based. Increased awareness of the epidemiology and spectrum of the clinical presentation of KD is essential for early recognition and optimal management.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Determining the rate of varicella vaccine rash in children with moderate-severe eczema.

OBJECTIVES: To determine the rate and severity of vesicular reactions following varicella vaccine in children with moderate-severe eczema. Secondary endpoints included the rates and severity of local reactions and eczema severity change within 42 days of vaccination. METHODS: Prospective open intervention pilot study of varicella vaccine in children aged 12 months to 13 years with moderate-severe eczema. Children were given varicella vaccine alone and followed for 42 days after vaccination. RESULTS: Fifty children, aged 12 months to 10.5 years were recruited, with complete follow-up for 48. A vesicular rash with a single lesion occurred in one child (2.1% (95% CI: 0, 11.1%)), 10 days following vaccination. Local reactions, including erythema, swelling and tenderness, were reported in eight children (16.7%). A flare-up of moderate-severe generalized eczema was reported in one child (2.1%) during the first week following varicella vaccine. CONCLUSIONS: Vesicular rash and local reactions following varicella vaccination were no more common or severe in children with moderate-severe eczema than that reported in the published literature in children without eczema. Eczema in the 42 days following vaccination did not appear to increase in severity.

Chickenpox Vaccine↗
PubMed1999

Asymmetries of cerebral perfusion in a stroke-age population.

Cerebral perfusion measurements with(99m)Tc-hexamethylpropyleneamine oxime single photon emission computed tomography (HMPAO SPECT) are potentially clinically useful in the investigation of patients with acute ischaemic stroke. The normal side-to-side asymmetry on(99m)Tc-HMPAO SPECT images may be greater in the stroke-age population than in younger age groups. To assess the extent of variation we studied 66 volunteers with(99m)Tc-HMPAO SPECT who were closely age matched to a stroke population and who had normal CT and extracranial and intracranial vascular ultrasonography. By measuring the side-to-side ratios in 19 regions of interest, the normal side-to-side perfusion asymmetry was determined and, as a secondary aim, variations in regional asymmetry were correlated with age. After repeated measurement analysis of variance (ANOVA), the normal range of side-to-side ratios in this population was 1.003+/-0.145 (mean+/-1.96 SD, ANOVA). The two regions with the greatest side-to-side asymmetry values were (1) the superior lateral temporal cortex (higher on the right relative to the left) and (2) the superior parietal cortex (higher on the left relative to the right). The orbitofrontal and posterior temporal cortices demonstrated significantly increased bidirectional variation with age (P< 0.05). In a stroke-age population hemispheric perfusion is relatively symmetrical and a side-to-side variation of greater than +/-14.5% may be defined as pathological. This value is higher than that reported in younger volunteers suggesting that there is a mild increase in the side-to-side perfusion asymmetry with age. Increased variation in the orbitofrontal and posterior temporal cortices occurs with age and should be borne in mind when interpreting HMPAO SPECT studies. Copyright 1999 Harcourt Publishers Ltd.

Journal Article↗
PubMed1999

Outbreak of extended spectrum beta lactamase producing Klebsiella pneumoniae in a neonatal unit.

An outbreak of extended spectrum beta lactamase producing Klebsiella pneumoniae (ESBLKp) in a neonatal unit was controlled using simple measures. Normally, the control of such infections can be time consuming and expensive. Seven cases of septicaemia resulted in two deaths. ESBLKp isolates were subtyped by pulsed field gel electrophoresis, and four of the five isolates typed were identical. Control of the outbreak was achieved by altered empiric antibiotic treatment for late onset sepsis and prevention of cross infection by strict attention to hand washing. Widespread colonisation of babies in the unit was presumed, so initial surveillance cultures were not performed. No further episodes of sepsis occurred.

Amikacin↗
PubMed1998

Should peri-operative infra-inguinal graft duplex scans be routinely performed?

BACKGROUND: The ability of duplex ultrasound graft surveillance to detect graft stenosis is well documented. However, the optimal time to commence duplex ultrasound graft surveillance is not clear. METHODS: An early duplex ultrasound study was performed on 90 infra-inguinal bypass grafts within 2 weeks of surgery. Further duplex scans were performed at intervals after surgery of 1 month, 3 months, 6 months, 1 year and then annually. An ankle/brachial systolic pressure index (ABI) was performed before the infra-inguinal bypass and then 24 h after the surgery. The ABI was also routinely measured at the time of each graft duplex examination. RESULTS: Six graft thromboses (6.7%) were demonstrated on the first graft duplex within 2 weeks of the surgery. The 24-hour postoperative resting ABI were less than 0.5 in all six cases. Significant graft stenoses (> 50%) or native artery diseases were detected in six cases (6.7%) on the first graft scan (proximal anastomosis stenosis, 1: mid-graft stenosis, 3; peroneal artery stenosis, 1; popliteal artery occlusion, 1). The resting ABI was less than 0.5 in one of these cases. Vein patch angioplasty was performed on graft stenosis in two cases following the first duplex scan. In 78 cases with either normal or minimal graft/native artery stenosis (< 50%), the resting ABI were less than 0.5 in only two cases (2.6%). The first graft duplex ultrasound examinations were technically difficult or gave a poor image in 21 cases (23.3%). During the subsequent graft duplex follow-up, seven graft thromboses were demonstrated at an average of 5.9 months after surgery (1-12 months). Significant stenosis (> 50%) was demonstrated in 10 additional cases at an average of 8.5 months after surgery (1-12 months). CONCLUSIONS: The data of the present study do not support routine peri-operative graft duplex scanning in addition to a 1-month graft duplex scan. Early postoperative resting ABI should be routinely performed. If the resting ABI is less than 0.5, an immediate duplex scan should be carried out to assess graft integrity. A long-term non-invasive graft surveillance programme is important in the detection of graft stenosis.

Aneurysm↗
PubMed1996

Combined semiclosed iliac endarterectomy and distal arterial reconstruction for multilevel arterial disease.

Semiclosed iliac endarterectomy in combination with an infrainguinal vascular reconstruction has been used over the past decade in the treatment of lower-limb ischaemia. Although the early results of this combination of operations were known, the durability of the external iliac endarterectomy had not been assessed and so an effort was made to review all surviving patients by duplex scanning. Between 1985 and 1993, 48 patients (51 limbs) underwent combined semiclosed iliac endarterectomy and infrainguinal vascular reconstruction for iliac and femoropopliteal occlusive disease. Some 49% of operations were performed for limb salvage. An iliofemoral bypass graft was required twice because of failure of the endarterectomy. A variety of distal arterial reconstructions was employed. One patient required a major amputation and there were two deaths. Mean (s.d.) ankle/brachial indices (ABI) rose from 0.54 (0.14) to 0.85 (0.25) after surgery. Some 85% of the patients who underwent operation for claudication became symptom free; 83% of patients who underwent operation for limb-threatening ischaemia became symptom free or improved to mild claudication during an average of 29 months follow-up. During the follow-up period five patients underwent a further procedure because of restenoses of the external iliac artery. A duplex scanning study was performed in 22 of the 51 limbs an average of 36 months after surgery. External iliac artery stenotic lesions were found in the area of the endarterectomy in three patients. Endarterectomy of the external iliac artery from the groin is an alternative for some patients with iliac arterial disease. In a patient scheduled for an infrainguinal bypass, when an unexpectedly greater degree of athermoma is found at operation in the common femoral and external iliac arteries, this operation may be performed. The durability of the operation as assessed by follow-up duplex scan is quite acceptable.

Aged↗
PubMed1996

Recurrent varicose veins after short saphenous vein surgery: a duplex ultrasound study.

Recurrent venous reflux in the popliteal fossa of patients with recurrent varicose veins following short saphenous vein surgery was assessed in 70 limbs using a duplex scanner. Incompetence of the short saphenous vein was found to be the main source (61%) of venous reflux in the popliteal fossa (43/70). The recurrence or persistence of the short saphenous vein was subdivided into four types: an intact saphenopopliteal junction, as well as an intact short saphenous vein in 20 limbs (type I): varicosities in the popliteal fossa communicating with a short saphenous vein stump in 11 limbs (type II); a residual short saphenous vein communicating with the popliteal vein via a tortuous recurrent vein in eight limbs (type III); and a segment of residual short saphenous vein with no communication with the popliteal vein in four limbs (type IV). Incompetence of a gastrocnemius vein was involved in 24 cases (34%), an incompetent popliteal area vein in one (1.4%), popliteal vein incompetence in 15 (21%), and popliteal fossa varicosities communicating with the long saphenous system in two (3%). Of 12 limbs tested pre- and postoperatively, a high termination of the short saphenous vein was demonstrated in four of seven residual incompetent short saphenous veins. Duplex scanning is recommended to assess recurrent venous reflux in the popliteal fossa. It can be used to determine the level of an incompetent saphenopopliteal junction and the level of the termination of any other incompetent vein in the management of varicose veins recurring after a short saphenous vein operation.

Follow-Up Studies↗
PubMed1996

Outcome of patients with symptomless carotid bruits: a prospective study.

Knowledge of the natural history of symptomless carotid artery disease is important in determining the best preventative treatment for symptom-free patients. To document the progression of carotid artery disease and the clinical course of a symptomless population, 336 patients with symptom-free carotid bruits were prospectively followed up initially with oculoplethysmography and subsequently with duplex scanning. During a mean follow-up of 4.87 years, eight patients (2.4%) suffered a stroke. Thirty-seven (11.0%) experienced transient ischaemic attacks (TIAS). The cumulative event rate (TIA plus stroke) was 13.4% (45/336). The annual event rates were 0.48% for stroke, 2.26% for TIA and 2.75% for all ischaemic events. In a subgroup of 69 high-grade carotid stenoses (80-99%), 31 carotid endarterectomies were performed before the development of a TIA or stroke and 21 after the development of symptoms, while 17 lesions were followed-up non-operatively. The total event rate (TIA and stroke) was significantly greater in the non-operated compared with the operated arteries (51.0% versus 6.4% at 5 years, P=0.0034). However, most of the events which occurred in the non-operated group were TIAs (85.7%) rather than stroke. There was no difference In the death rate of the two groups (P>0.05). Review of serial duplex studies performed on 540 carotid arteries revealed that 382 arteries (70.7%) remained unchanged and 158 (29.3%) showed disease progression. Forty-four of the 540 arteries became symptomatic (TIA or stroke). In 29 of the 44, the event occurred without any change in diameter of the artery, while in 15 there was a change of at least one category greater stenosis. In 39 patients, the stenosis was at least 40% and in five the stenosis was under 40%. Nine events occurred in the patients with severe contralateral carotid stenoses (>60%). The incidence of TIA (32.2%), stroke (6.8%) and death (18.6%) was higher in patients with internal carotid artery stenoses in excess of 80% than in those with lesions between 0 and 79% stenosis (P<0.0001, P= 0.0367 and P=0.0236, respectively). In this study the incidence of cerebrovascular events was higher in patients with high-grade internal carotid artery disease, and the preservation of neurological status in patients with symptomless high-grade carotid artery stenosis was improved by carotid endarterectomy, although the overall mortality remained unchanged.

Adult↗
PubMed1995

Recurrent varicose veins following high ligation of long saphenous vein: a duplex ultrasound study.

Duplex scanning was used to study recurrent varicose veins in 244 limbs with previous high ligation of the long saphenous vein. The recurrent varicose veins were classified into two types according to the presence or absence of a residual long saphenous vein. Varicose veins with a residual long saphenous vein (type I) occurred in 168 limbs (68.9%). A residual long saphenous vein with an incompetent saphenofemoral junction was present in 125 limbs and one without any residual saphenofemoral junction in 43 limbs. Besides the presence of an incompetent long saphenous vein in this group, an incompetent short saphenous vein was detected in 26 limbs, incompetent perforating vein(s) in 45 limbs and incompetent deep veins in 26 limbs. Varicose veins without a residual long saphenous vein (type II) occurred in 76 limbs (31.1%). An incompetent short saphenous vein was demonstrated in 44 limbs, incompetent perforating vein(s) in 18 limbs and incompetent deep veins in 32 limbs. Of the total 244 limbs with recurrent varicose veins, long saphenous vein incompetence was involved in 168 (68.9%), short saphenous vein incompetence in 70 (28.7%), perforating vein incompetence in 63 (25.8%) and deep venous incompetence in 58 (23.8%). Although saphenofemoral junction incompetence was found to be the main source of recurrence, a segment of incompetent residual long saphenous vein, an incompetent short saphenous vein, perforating vein and deep venous system incompetence are other common sources of recurrence. A precise assessment to identify underlying venous incompetence is important for the management of recurrent varicose veins.

Humans↗
PubMed1995

Duplex ultrasound assessment of the venous status of the swollen leg.

Between January 1991 and December 1993, duplex ultrasound characterization of venous disease in leg swelling was studied in 214 patients (261 limbs; 167 unilateral and 47 bilateral). All patients were examined with a duplex scanner, the superficial and deep venous systems were evaluated for the presence of thrombus and valvular incompetence. Of the 261 limbs, 29 (11.1%) had deep venous thrombosis, 14 (5.4%) had superficial venous thrombosis, 66 (25.3%) had deep venous incompetence (31/66 limbs also had superficial venous incompetence), 65 (24.9%) had incompetence in the superficial veins only, and five (1.9%) had deep venous obstruction resulting from a popliteal cyst or a popliteal vein ligation. Eighty-two limbs (31.4%) had no evidence of venous obstruction or incompetence at the areas evaluated. This study showed that venous obstruction and valvular incompetence had occurred in two-thirds of swollen legs examined. Some of the venous obstructions resulted from surgically treatable diseases such as a popliteal cyst, and some of the venous disorders involved the superficial venous system only. Complete venous evaluation with duplex imaging can be very helpful in the determination of the underlying cause of the swelling.

Adolescent↗