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Biomedical subjects

J Skinner

Publications and source records attributed to J Skinner.

At least 19 recordsLinked to original sources
PubMed2006

High-resolution magnetic resonance cholangiography (MRC) with adaptive averaging: diagnostic performance evaluation.

AIM: To evaluate the diagnostic performance of an interactive, adaptively averaged (AA) two-dimensional (2D) magnetic resonance cholangiography (MRC) technique in patients with suspected biliary disease by comparison to the standard MRC technique. MATERIALS AND METHODS: The AA 2D MRC method registers the images after acquisition, allowing summation of multiple images to improve the signal:noise ratio (SNR) and thereby potentially improve the visualization of bile ducts. One hundred and twenty-eight patients underwent both 2D conventional and AA magnetic resonance cholangiopancreatography (MRCP). Twenty-seven patients were excluded from the analysis as AA images could not be properly obtained due to technical failures. All examinations were performed using a 1.5 T whole-body MR system and a four-channel torso phased array coil. Images of 101 patients were adaptively averaged using an in-house developed program written in IDL. Two readers qualitatively evaluated the studies in consensus, blinded to acquisition details and without knowledge of clinical information. RESULTS: The AA technique was significantly better than the conventional 2D MRC for the visualization of the second-order branch intrahepatic ducts (p<00001). Overall, there was no significant difference in the diagnostic confidence between two techniques (p=0.12). However, the AA technique showed a trend towards more confident diagnosis of biliary strictures (p=0.055), likely due to better diagnostic confidence in identifying second order branch intrahepatic duct strictures (p=0.054). CONCLUSION: Excluding those patients those patients in whom either satisfactory respiratory gating or a suitable kernel placement was not achieved, AA 2D MRC demonstrated a significant improvement in visualization of intrahepatic duct branches compared to standard MRC.

Adolescent↗
PubMed2006

A knee-sparing distal femoral endoprosthesis using hydroxyapatite-coated extracortical plates. Preliminary results.

We used a knee-sparing distal femoral endoprosthesis in young patients with malignant bone tumours of the distal femur in whom it was possible to resect the tumour and to preserve the distal femoral condyles. The proximal shaft of the endoprosthesis had a coated hydroxyapatite collar, while the distal end had hydroxyapatite-coated extracortical plates to secure it to the small residual femoral condylar fragment. We reviewed the preliminary results of this endoprosthesis in eight patients with primary bone tumours of the distal femur. Their mean age at surgery was 17.years (14 to 21). The mean follow-up was 24 months (20 to 31). At final follow-up the mean flexion at the knee was 102 degrees (20 degrees to 120 degrees) and the mean Musculoskeletal Tumour Society score was 80% (57% to 96.7%). There was excellent osteointegration at the prosthesis-proximal bone interface with formation of new bone around the hydroxyapatite collar. The prosthesis allowed preservation of the knee and achieved a good functional result. Formation of new bone and remodelling at the interface make the implant more secure. Further follow-up is required to determine the long-term structural integrity of the prosthesis.

Adolescent↗
PubMed2006

The association between metal ions from hip resurfacing and reduced T-cell counts.

We have studied the relationship between metal ion levels and lymphocyte counts in patients with metal-on-metal hip resurfacings. Peripheral blood samples were analysed for lymphocyte subtypes and whole blood cobalt and chromium ion levels in 68 patients (34 with metal-on-metal hip resurfacings and 34 with standard metal-on-polyethylene total hip replacements). All hip components were radiologically well-fixed and the patients were asymptomatic. Cobalt and chromium levels were significantly elevated in the patients with metal-on-metal hip resurfacings, compared with the patients with standard metal-on-polyethylene designs (p < 0.0001). There was a statistically significant decrease in the level of CD8(+) cells (T-cytotoxic/suppressor) (p = 0.005) in the metal-on-metal hip resurfacing group. A threshold level of blood cobalt and chromium ions was associated with reduced CD8(+) T-cell counts. We have no evidence that our patients suffered as a result of this reduced level of CD8(+) T-cells.

Adult↗
PubMed2005

Risk of cervical injuries in mixed martial arts.

BACKGROUND: Mixed martial arts have rapidly succeeded boxing as the world's most popular full contact sport, and the incidence of injury is recognised to be high. OBJECTIVE: To assess qualitatively and quantitatively the potential risk for participants to sustain cervical spine and associated soft tissue injuries. METHODS: Four commonly performed manoeuvres with possible risks to the cervical spine were analysed with respect to their kinematics, and biomechanical models were constructed. RESULTS: Motion analysis of two manoeuvres revealed strong correlations with rear end motor vehicle impact injuries, and kinematics of the remaining two suggested a strong risk of injury. Mathematical models of the biomechanics showed that the forces involved are of the same order as those involved in whiplash injuries and of the same magnitude as compression injuries of the cervical spine. CONCLUSIONS: This study shows that there is a significant risk of whiplash injuries in this sport, and there are no safety regulations to address these concerns.

Adult↗
PubMed2004

Intake of dietary plant sterols is inversely related to serum cholesterol concentration in men and women in the EPIC Norfolk population: a cross-sectional study.

OBJECTIVE: We examined the relation between intake of natural dietary plant sterols and serum lipid concentrations in a free-living population. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional population-based study of 22,256 men and women aged 39-79 y resident in Norfolk, UK, participating in the European Prospective Investigation into Cancer (EPIC-Norfolk). MAIN EXPOSURE AND OUTCOME MEASURES: Plant sterol intake from foods and concentrations of blood lipids. RESULTS: Mean concentrations of total cholesterol and low-density lipoprotein cholesterol, adjusted for age, body mass index and total energy intake, decreased with increasing plant sterol intake in men and women. Mean total serum cholesterol concentration for men in the highest fifth of plant sterol intake (mean intake 463 mg daily) was 0.25 mmol/l lower and for low-density lipoprotein cholesterol 0.14 mmol/l lower than those in the lowest fifth of plant sterol consumption (mean intake 178 mg daily); the corresponding figures in women were 0.15 and 0.13 mmol/l. After adjusting for saturated fat and fibre intakes, the results for total cholesterol and low-density lipoprotein cholesterol were similar, although the strength of the association was slightly reduced. CONCLUSIONS: In a free-living population, a high intake of plant sterols is inversely associated with lower concentrations of total and low-density lipoprotein serum cholesterol. The plant sterol content of foods may partly explain diet-related effects on serum cholesterol concentration.

Adult↗
PubMed2003

The efficacy of bacitracin methylene disalicylate when fed in combination with narasin in the management of necrotic enteritis in broiler chickens.

The efficacy of bacitracin methylene disalicylate (BMD) in the management of necrotic enteritis (NE) when fed in combination with narasin was investigated in a floor-pen study of 2,000 broiler chickens using a Clostridium perfringens inoculum challenge model. Treatments consisted of 1) nonchallenged-nonmedicated; 2) challenged-nonmedicated; 3) challenged-narasin (70 ppm); 4) challenged-BMD (55 ppm); 5) challenged-narasin (70 ppm) + BMD (55 ppm). Medication was provided in the feed from Day 0 to trial termination on Day 41. C. perfringens challenge occurred from Day 14 to 16. BMD and narasin, fed alone and in combination, reduced (P < 0.05) mortality due to NE when compared to challenged-nonmedicated birds. NE lesion scores (Days 0 through 41) were lower among birds fed BMD and narasin, alone and in combination, compared to challenged-nonmedicated birds. Improvements in NE mortality and NE lesion scores were greatest for the BMD + narasin-medicated birds, followed by the BMD-alone, and then narasin-alone treated birds. BMD and narasin, alone and in combination, provided improvements (P < 0.05) in average daily gains over the entire study (Days 0 to 41). The results of this study demonstrate the effectiveness of BMD and narasin in the management of NE in broiler chickens.

Animals↗
PubMed2002

Exposure to power frequency electric fields and the risk of childhood cancer in the UK.

The United Kingdom Childhood Cancer Study, a population-based case-control study covering the whole of Great Britain, incorporated a pilot study measuring electric fields. Measurements were made in the homes of 473 children who were diagnosed with a malignant neoplasm between 1992 and 1996 and who were aged 0-14 at diagnosis, together with 453 controls matched on age, sex and geographical location. Exposure assessments comprised resultant spot measurements in the child's bedroom and the family living-room. Temporal stability of bedroom fields was investigated through continuous logging of the 48-h vertical component at the child's bedside supported by repeat spot measurements. The principal exposure metric used was the mean of the pillow and bed centre measurements. For the 273 cases and 276 controls with fully validated measures, comparing those with a measured electric field exposure >/=20 V m(-1) to those in a reference category of exposure <10 V m(-1), odds ratios of 1.31 (95% confidence interval 0.68-2.54) for acute lymphoblastic leukaemia, 1.32 (95% confidence interval 0.73-2.39) for total leukaemia, 2.12 (95% confidence interval 0.78-5.78) for central nervous system cancers and 1.26 (95% confidence interval 0.77-2.07) for all malignancies were obtained. When considering the 426 cases and 419 controls with no invalid measures, the corresponding odds ratios were 0.86 (95% confidence interval 0.49-1.51) for acute lymphoblastic leukaemia, 0.93 (95% confidence interval 0.56-1.54) for total leukaemia, 1.43 (95% confidence interval 0.68-3.02) for central nervous system cancers and 0.90 (95% confidence interval 0.59-1.35) for all malignancies. With exposure modelled as a continuous variable, odds ratios for an increase in the principal metric of 10 V m(-1) were close to unity for all disease categories, never differing significantly from one.

Adolescent↗
PubMed2002

Staphylococcus aureus endocarditis in preterm neonates.

This article describes three extremely low birth weight infants with Staphylococcus aureus septicemia associated with insertion of a percutaneous central venous catheter who later developed endocarditis. Echocardiography demonstrated large vegetations although only one infant had a murmur. Following a 6-week course of intravenous flucloxacillin and netilmicin, the endocarditis completely resolved and further intervention was unnecessary, although one baby died later as a result of volvulus and chronic lung disease. Echocardiography should be performed to exclude invasive infection in infants with S. aureus septicemia even when there is no murmur or other evidence of endocarditis. If endocarditis is identified, a good outcome is possible with appropriate aggressive antibiotic therapy.

Anti-Bacterial Agents↗
PubMed2002

Transient synovitis: is there a need to aspirate hip joint effusions?

There is debate as to the optimal management of children with hip joint effusions especially regarding the decision to aspirate. The objective of this study was to determine whether there is a need to aspirate hip joint effusions detected on ultrasound in patients with clinical transient synovitis (TS) and to identify the natural history of these effusions. Twenty-five children with proven hip joint effusions were followed up sequentially by clinical and radiological examination until symptom free. The mean age was 6 years with equal right/left distribution. No child underwent hip aspiration and no cases of sepsis were missed. The median size of hip effusion detected on ultrasound at presentation was 9 mm. At 7 days 60% (15/25) of patients had a normal clinical examination with no detectable effusion on ultrasound. At 14 days 16% (4/25) had an effusion detectable on ultrasound but they were all pain and limp free and their effusions were reducing in size. These results support the known benign nature of TS and that it will settle with conservative treatment.

Child↗
PubMed2001

Telomerase activity and telomere length in thyroid neoplasia: biological and clinical implications.

Despite several recent studies, the biological status and clinical relevance of telomerase expression in tumours derived from the thyroid follicular cell remain controversial. This study has analysed a series of normal, benign, and malignant thyroid samples using two novel approaches: the use of purified epithelial cell fractions to eliminate false-positives due to telomerase-positive infiltrating lymphocytes; and the simultaneous measurement of telomere length to provide a clearer interpretation of telomere dynamics in thyroid neoplasia. The data obtained support the prediction that the epithelial component of non-neoplastic thyroid and of follicular adenomas is telomerase-negative, any positive results being explicable by lymphocyte infiltration. In contrast, many malignant tumours, both follicular and papillary, were telomerase-positive. However, serial dilution of extracts indicated a wide spectrum of activity in these cancers, possibly related to variation in the proportion of telomerase-positive cells. Furthermore, an unexpectedly high proportion were telomerase-negative, a finding which was not explicable by technical problems such as TRAP (telomeric repeat amplification protocol) assay sensitivity. Many of these apparently telomerase-negative tumours had abnormally long telomeres. Correlation of telomerase and telomere length data suggests that thyroid cancers fall into three biological groups: telomerase-positive lesions, consistent with the conventional model of telomere erosion followed by telomerase reactivation; telomerase-negative tumours, which maintain telomere length by a mechanism independent of telomerase; and telomerase-negative tumours which are still undergoing telomere erosion and may therefore be composed of mortal cancer cells. From a clinical standpoint, it is concluded that telomerase detection on unfractionated tissue, such as fine needle aspirates, is of no value as a marker of malignancy in follicular lesions, due to both low sensitivity and specificity.

Adenoma↗
PubMed2001

Fetal DNA in maternal circulation of first-trimester spontaneous abortions.

OBJECTIVE: To establish whether fetal DNA can be identified in the maternal circulation in first-trimester spontaneous abortions. METHODS: Women with confirmed spontaneous abortions and no histories of previous pregnancy were recruited. Peripheral venous blood samples were obtained and DNA extracted. Real-time quantitative polymerase chain reaction was done using SRY and beta-actin systems for calculating fetal and total DNA, respectively. RESULTS: Of 25 women, SRY-specific signals were detected in 11 indicating that the abortions were male. The remaining 14 were negative for the SRY gene. Women with positive results were of similar gestational age to those who were negative (mean 68.4 and 69.0 days). Fetal:total DNA ratio was calculated for positive samples and ranged from 15.8 to 360.1 x 10(+3). Mean ratio was 99.4 x 10(+3) and median was 67.5 x 10(+3). CONCLUSION: Fetal DNA is present in the maternal circulation of first-trimester spontaneous abortions.

Abortion, Spontaneous↗
PubMed2001

Diagnosis of patent ductus arteriosus.

This review shows that clinical signs cannot be relied on to reveal left-to-right ductal shunting in the preterm. Echocardiography can define many of the haemodynamic features, including occult ventricular dysfunction, and categorize shunts into small, moderate or large, without defining "significance" which is multifactorial. Large shunts have an elevated left atrial:aortic root ratio (>1.3:1 or >1.5:1, depending on fluid and diuretic policy) a ductal diameter >1.4 mm and retrograde diastolic flow in the descending aorta exceeding 30% of the antegrade flow. The neonatal clinician and echocardiographer is reminded to remain wary of occult congenital heart disease, particularly before closing the ductus.

Diagnosis, Differential↗
PubMed2001

An audit of patients investigated by laparoscopy and dye for infertility.

We reviewed 100 laparoscopy and dye studies performed in the Coombe Women's Hospital to determine whether recommended guidelines were followed for the investigation of infertility. Individual chart review provided information on patient demographics, preoperative investigations, operative findings and outcome. Preoperative assessment of ovulation or a semen analysis was not performed in 20 and 30 women, respectively. At laparoscopy bilateral tubal patency was demonstrated in 86 patients, three patients had bilateral blocked tubes and 11 patients had unilateral tubal occlusion. In 54% of patients there were no other additional findings. Following laparoscopy five women were referred for in vitro fertilisation and five patients had further surgery as a result of the findings at laparoscopy. In addition, three women were treated for hyperprolactinaemia and three male partners were referred for further investigation. Within one year 20 women became pregnant, 18 delivered a baby and two had a miscarriage.

Journal Article↗
PubMed2001

Is fetal abdominal subcutaneous fat comparable with established indices of growth restriction?

The purpose of this study was to determine if measurement of the abdominal subcutaneous fat antenatally using ultrasound is comparable to other established indices of fetal growth restriction (FGR). One hundred women with singleton pregnancies had an ultrasound scan within 1 week of delivery at term. Ultrasound measurements included abdominal circumference (AC), liquor assessment by amniotic fluid index (AFI) and abdominal subcutaneous fat thickness (FAB). After delivery,infants were weighed and skinfold thickness at triceps and subscapular sites measured. Ponderal index was also calculated. Infants with an abdominal subcutaneous fat measurement antenatally of 5 mm or less (n = 41) were more likely than those with a fat measurement of more than 5 mm (n = 59) to have an AFI < 8 cm (P < 0.001) and to have an AC < 10th centile (P < 0.001). Decreased antenatal fat thickness was associated postnatally with a lower mean ponderal index (24.2 kg/m3 vs. 25.5 kg/m3, P < 0.02) and a decreased skinfold thickness (4.84 vs. 5.55 mm, P < 0.003 and 3.88 vs. 4.37, P < 0.03 for triceps and subscapular, respectively). This study shows that fetal abdominal subcutaneous fat measurement correlates with established predictors of fetal nutrition such as liquor volume, abdominal circumference, ponderal index, triceps and subscapular skinfold thickness.

Journal Article↗
PubMed2001

Mobile thoracolumbar gibbus in Morquio type A: the cause of paraparesis and its management.

Four children with Morquio A syndrome had neurologic deterioration related to a progressive thoracolumbar gibbus. Findings on the magnetic resonance imaging scan did not suggest a significant canal compromise, but X-rays taken in the erect position showed a much larger kyphosis, and thus more canal compromise. All patients recovered neurologically after anterior decompression and correction of kyphosis. We believe that the cause of cord dysfunction is mobility at the kyphus and compression by the bulging discs and the internal gibbus.

Child↗
PubMed2000

A prospective study of seeding of the skin after core biopsy of the breast.

BACKGROUND: The number of core biopsies done for breast abnormalities is increasing. The risk of skin seeding resulting from core biopsy is unknown. METHODS: Consecutive patients diagnosed with breast cancer were studied. The skin and subcutaneous fat surrounding the site of core needle penetration were excised and studied by routine histologic staining. Findings were correlated with other clinical variables. RESULTS: Eighty-nine consecutive patients were studied. Thirty-one had stereotactic core biopsies, 23 had vacuum-assisted biopsy, 8 had multiple-puncture biopsy, and 58 had ultrasound-guided core biopsy. Two patients who were biopsied using multiple-puncture biopsy were found to have nests of cancer cells in the dermis. One of these patients had recurrence in the skin biopsy site at 34 months. CONCLUSION: Skin seeding may be important in light of increasing use of image-directed biopsy, and particularly for cases in which the biopsy puncture site is outside the index quadrant and in which no radiation is anticipated.

Adenocarcinoma↗