Biomedical subjects
L Dodd
Publications and source records attributed to L Dodd.
Evaluation of delivery of enhanced diabetes care to patients of South Asian ethnicity: the United Kingdom Asian Diabetes Study (UKADS).
AIMS: We tested the hypothesis that enhanced care for diabetes, tailored to the needs of the South Asian community with Type 2 diabetes, would improve risk factors for diabetic vascular complications and ultimately reduce morbidity and mortality. PATIENTS AND METHODS: The study was a cluster randomized controlled trial (RCT) with general practice the unit of randomization. Six West Midlands general practices with a high proportion of South Asian patients were randomized to 'enhanced care' using Asian link workers and extra community diabetes specialist nurse sessions (intervention) or continued standard practice care (control). RESULTS: Of 401 patients recruited to the study, 361 (90%), comprising 178 from Coventry and 183 from Birmingham were eligible and included in the analyses. The mean age at baseline (standard deviation, SD) was 58.9 (11.7 years) with median (interquartile range; IQR) duration of diabetes 6.5 (3-11) years. At one year follow-up there was a significant difference in reduction of systolic (4.6 mmHg, P = 0.035) and diastolic blood pressure (3.4 mmHg, P = 0.003) and total cholesterol (0.4 mmol/l, P = 0.005), comparing the intervention and control groups. After adjusting for baseline measurement and age, only differential reduction in diastolic blood pressure remained significant. There was no significant change in HbA(1c) and no difference between the groups. CONCLUSIONS: Using link workers and extra community diabetes specialist nurse input together with treatment protocols in primary care might prove a useful strategy in working towards NSF targets for diabetes management. In this study, small reductions in blood pressure and cholesterol were achieved. Improvement in glycaemic control may require longer and possibly different strategies. Further research is required to evaluate fully the effectiveness, including the costs and longer term sustainability of culturally sensitive initiatives.
Granular cell tumors of the extremities.
Granular cell tumors are uncommon tumors that may arise from various soft tissue and visceral sites. These lesions often are multifocal but, with rare exceptions, are benign. Much of the literature on granular cell tumors is based on case reports mostly in the otolaryngology literature, and most series are limited to histopathologic studies. There are no documented series of cases in the orthopaedic literature. Granular cell tumors do occur in the extremities; thus, patients with a peripheral granular cell tumor may be referred to an orthopaedist. Ten cases of benign granular cell tumor treated at the authors' institution between 1993 and 1999 are reported. Five tumors of the thigh and one tumor of the groin were treated with wide excision, whereas three tumors of the hand and one tumor of the elbow were treated with marginal resection. Although two tumors treated with attempted wide excision had positive margins, none of the tumors have recurred after an average followup of 27 months. The presentation, radiography, histologic findings, and treatment of benign granular cell tumors that distinguish it from other soft tissue lesions are discussed.
Safety and effectiveness of nurse telephone consultation in out of hours primary care. Tolerance limits were too wide.
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Case report 700: Primary intracortical osteosarcoma of femur, sclerosing variant, grade 1 to 2 anaplasia.
We report a case of intracortical OS of the mid-femur in a 43-year-old man. The patient is the oldest reported to date. Histologically, the tumor was a sclerosing variant of OS with extensive "normalization" of nuclei. This is the most common histological subtype of intracortical OS. The patient was treated by en bloc resection without preoperative or systemic chemotherapy and is without evidence of disease with 15 months' follow-up.
Early changes in fiber profile and capillary density in long-term stimulated muscles.
Predominantly fast skeletal muscles of rabbits [tibialis anterior (TA), extensor digitorum longus (EDL)] were stimulated at a frequency naturally occurring in nerves to slow muscles (10 Hz continuously) for 8 h/day for 2--4 days. Such stimulation is known to convert all glycolytic fibers to oxidative and to increase capillary density. Our aim was to study early stages of conversion to investigate the factors responsible for the changes. Staining of quick-frozen sections for myosin ATPase, succinic dehydrogenase, and alkaline phosphatase was used to study the distribution of different fiber types and to measure fiber cross-sectional areas, capillaries per square millimeter, and capillary-to-fiber ratios in each fiber category. TA but not EDL showed conversion of fast glycolytic to fast oxidative fibers after 2 days, more after 4 days of stimulation. In both muscles, the largest fast glycolytic fibers were diminished in number after stimulation. There was significant increase in total capillaries per square millimeter after 4 days and some increase after 2 days of stimulation. The increase in capillaries per square millimeter exceeded the increase in the number of fibers per square millimeter, and since there was no change in mean fiber area, the increase is attributed to capillary growth. In EDL, there was an increase in the number of capillaries supplying both fast glycolytic and fast oxidative fibers, suggesting that capillary growth precedes fiber type conversion. In TA, the number of capillaries supplying fast oxidative fibers was increased but that to fast glycolytic fibers, was not. This is consistent with capillary growth simultaneous with or following fiber conversion. In both TA and EDL the number of capillaries perfused after contraction was higher in stimulated muscles, suggesting that increased capillary flow contributed to capillary growth.
Carcinomas of the lacrimal drainage system.
Primary carcinomas of the lacrimal drainage system are rare. These malignant neoplasms typically present as noncompressible, nontender masses with low-grade dacyrocystitis and/or unilateral epiphora. Lymph node metastasis may occur late in the disease course. Complete surgical resection is the best treatment choice; extensive procedures such as orbital exenteration and maxillectomy may be necessary for complete tumor extirpation. Further adjunctive radiotherapy may improve local control. We present two cases of carcinoma of the lacrimal drainage system, including one locally controlled tumor with apparent lymph node metastasis that occurred 21 years after primary treatment. A review of the histopathology and literature concerning carcinomas of the lacrimal drainage system is presented.
Case report. Pericardial hemangioma.
Hemangiomas are rare cardiac and pericardial neoplasms, with the majority diagnosed incidentally at autopsy. Pericardial hemangiomas typically arise from visceral pericardium, and most are cavernous hemangiomas. They are usually solitary and well circumscribed and range in size from 1 to 13.5 cm. Intense central contrast enhancement on CT and high signal on T2-weighted images suggest the diagnosis and can assist in preoperative surgical planning.
Stroke, catheters and constipation: action plans.
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