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Biomedical subjects

K Bibby

Publications and source records attributed to K Bibby.

17 recordsLinked to original sources
PubMed1999

Cytomegalovirus viraemia has poor predictive value for the development of cytomegalovirus disease in patients with advanced HIV-infection.

OBJECTIVE: Cytomegalovirus (CMV) continues to be one of the most important opportunistic infections associated with human immunodeficiency virus (HIV) infection. This study investigated the value of CMV-viraemia in predicting the development of clinical CMV disease in patients with advanced HIV infection. METHODS: This was a prospective observational study performed over a 2-year period between 1994-96 in the Department of Infection and Tropical Medicine at Leicester Royal Infirmary. Adult HIV-positive patients attending a hospital clinic were included if they were CMV-seropositive with CD4 counts < or =50 cells/mm3. Subjects were seen at approximately 6-weekly intervals in the clinic and were reviewed by an experienced ophthalmologist. Serum for CMV PCR was taken and stored at regular intervals and qualitative and quantitative PCR was performed at the end of the study period. The value of PCR in predicting the development of CMV disease was then assessed. RESULTS: Twenty-six patients were followed up during the study period and 77 evaluable specimens were analysed for CMV PCR. Twenty-three (30%) samples were positive and 54 negative. Seven (27%) patients developed CMV disease (five retinitis alone, and two with retinitis and oesophagitis) during the study period. Viraemia was often intermittent and there was no significant difference in the proportions of patients with positive or negative tests who subsequently developed CMV disease. The sensitivity, specificity, positive and negative predictive values of the qualitative PCR were 71%, 47%, 33% and 82% respectively and 57%, 74%, 44% and 82% respectively for the quantitative PCR (>10(3) copies/ml). CONCLUSIONS: The results from this study, which was performed before the introduction of protease inhibitors, found that cytomegalovirus PCR was of limited clinical value in predicting the patients at greatest risk of developing CMV-disease and provided little useful prognostic information.

AIDS-Related Opportunistic Infections↗
PubMed1998

Retention and stability: a review of the literature.

Long-term posttreatment stability is an issue of great concern to all orthodontists. This article highlights the factors reported to play a role in posttreatment crowding and reviews the long-term retention studies evaluating the stability of various treatment modalities. Recommendations, based on well-documented basic principles, are made to try to insure greater posttreatment stability of our orthodontically treated cases.

Adaptation, Biological↗
PubMed1997

Sellar and suprasellar hemangiopericytoma mimicking pituitary adenoma.

Hemangiopericytoma is a vascular neoplasm of variable and unpredictable malignancy, composed of proliferating capillary pericytes surrounding endothelial-lined tubes or sprouts. The histological appearance is diagnostic. The treatment of primary intracranial hemangiopericytoma is surgical excision, supplemented by radiotherapy. Local tumor recurrence after many years is common, and late and widespread metastasis can occur. Long-term follow-up is mandatory.

Adenoma↗
PubMed1997

The "harlequin" sign and congenital Horner's syndrome.

When trying to establish the likely anatomical site (preganglionic or postganglionic) of a lesion causing congenital Horner's syndrome, the distribution of facial flushing (the "harlequin" sign), may be seen. In babies and young children, facial flushing is a relatively simple clinical sign to demonstrate, compared with facial sweating. In unilateral facial flushing the areas that do not flush are almost always identical to the anhidrotic areas. However, neither facial flushing nor testing the pupil reactions with pholedrine or hydroxyamphetamine can be relied on to predict the probable site of any lesion causing congenital Horner's syndrome. Two patients with congenital Horner's syndrome are presented which demonstrated the "harlequin" sign and in whom clinical examination and pharmacological testing gave conflicting evidence for localisation of the site of the causative lesion. The presentation of congenital Horner's syndrome should be investigated and include MRI or CT to exclude a serious underlying cause.

Child↗
PubMed1994

Fibrous dysplasia of the orbit.

Twelve patients with fibrous dysplasia of the orbit are reviewed and the ophthalmic findings described. Three case histories are presented in detail. Six patients were managed conservatively; four have shown radiological progression of the disease. Six patients underwent surgery. A conservative procedure, comprising debulking dysplastic bone, was carried out in four--all required further surgery including radical excision in two patients. Two subjects had primary radical operations. No recurrence was encountered in the four patients who had undergone radical surgery. It would appear that fibrous dysplasia is not a disease confined to adolescence but may continue into adulthood, and even middle age. Patients may never require surgery, but require follow up for late progression. If surgical intervention is deemed necessary, an attempt should be made to excise all dysplastic bone, since progression of the disease after conservative surgery is relatively common.

Adolescent↗
PubMed1992

Benefits of training junior physicians to detect diabetic retinopathy--the Glasgow experience.

The accuracy and appropriateness of 115 consecutive referrals by non-consultant physicians to a specialist Diabetic Retinopathy Clinic were assessed in a retrospective study. The source of the referrals was masked throughout the study. Referrals were classed as 'appropriate' or 'inappropriate' for patient management, and the referral diagnosis (where specified) was compared with the ophthalmologist's initial assessment. It was graded as 'correct', 'partly correct' and 'incorrect'. Referrals from physicians who had received 40-50 hours of outpatient training in the Diabetic Retinopathy Clinic (group A, n = 49) were compared with referrals from doctors without this special instruction (group B, n = 66). Referral was deemed 'appropriate' in 32 (65%) of group A referrals, but in only 22 (33%) of group B (chi 2 = 11.54, df = 1, P less than 0.001). Referral diagnosis (when expressed) was graded as 'correct' in 28 (67%) of group A referrals compared with only 12 (30%) of group B, being 'incorrect' in 10 (25%) of group B referrals and just two (4.5%) of group A (chi 2 = 12.9, df = 2, P less than 0.005). Regular fundoscopy with accurate assessment and appropriate action is vital to prevent loss of vision in diabetic patients. Short-term outpatient training in a Diabetic Eye Clinic leads junior physicians to more appropriate referral and more accurate referral diagnosis.

Diabetic Retinopathy↗