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Biomedical subjects

L McClelland

Publications and source records attributed to L McClelland.

14 recordsLinked to original sources
PubMed2006

Paediatric fibro-osseous lesions of the nose and paranasal sinuses.

OBJECTIVE: The term "fibro-osseous lesion" is a generic description for a group of lesions involving the paranasal sinuses and anterior skull base. We aim to improve understanding of the clinical and pathological presentation of fibro-osseous lesions in children. METHODS AND RESULTS: We report two cases of aggressive "fibro-osseous" lesions arising from paranasal sinuses and anterior skull base in childhood that were successfully managed surgically. We compare our case reports with a review of the available literature and evaluate the management of these lesions. CONCLUSIONS: The clinical behaviour and radiological features of fibro-osseous lesions is variable. Aggressive lesions require a radical surgical approach to ensure complete excision, in spite of an increase in associated morbidity. Incomplete excision of aggressive lesions may result in disease recurrence with severe morbidity or mortality. In contrast a slowly progressive lesion often does not warrant extensive surgical excision. Understanding the nature of fibro-osseous lesions facilitates appropriate clinical management.

Adolescent↗
PubMed2005

Sinonasal cerebrospinal fluid leaks: management of 97 patients over 10 years.

INTRODUCTION: Although endoscopic closure is now the treatment of choice in the majority of patients with sinonasal cerebrospinal fluid (CSF) leaks, there is a recurrence rate of up to 10% in most series. OBJECTIVES: Our aim was to review our experience in the management of CSF leaks and in particular the cause of recurrent leaks. METHODS: We prospectively collected data on all cases referred as a suspected CSF leak to us, a tertiary referral center, over a 10 year period between 1994 and 2004. RESULTS: The 121 patients referred with an apparent CSF leak had a mean age of 51 (range 2-87) years. Fifty-three percent were male, and 47% were female. In 24 cases, investigations revealed that there was in fact no CSF leak, and in 17 posttraumatic cases, the leak ceased spontaneously. Twenty-nine patients had a spontaneous CSF leak. Of the 80 cases surgically repaired, 72 had an endoscopic approach, with a success rate of 90%, increasing to 97% after a second procedure and 99% by a third procedure. Eight patients with a posterior wall frontal sinus leak underwent an external frontal sinus procedure. There were 8 failures, and 6 occurred in the 13 patients with a spontaneous leak and evidence of raised intracranial pressure (ICP). CONCLUSIONS: In conclusion, our endoscopic repair rate for sinonasal CSF leaks are good and compare well with the standards in the literature. Raised ICP is the most common reason for recurrent CSF leak after repair. Patients with a spontaneous CSF leak and evidence of raised ICP had a 46% failure rate. When consenting such patients for surgery, they must be informed of the lower success rate and that they may need additional procedures, including shunting.

Adolescent↗
PubMed2005

Tonsillectomy: haemorrhaging ideas.

Tonsil surgery has been described for over 3000 years. Haemorrhage following tonsillectomy remains the most serious complication of surgery. Over recent years several audits have been gathering data on current trends in tonsil surgery and clinical outcomes throughout England, Scotland and Northern Ireland. The results support a return to traditional dissection with ties to reduce the risk of post-operative haemorrhage. We describe the changes that have occurred to improve efficacy and safety during the evolution of the modern tonsillectomy.

Electrocoagulation↗
PubMed2004

Impact of a critical care outreach team on critical care readmissions and mortality.

AIMS: The aim of a critical care outreach team is to facilitate discharges from critical care beds, educate ward staff in the management of deteriorating patients, facilitate transfer to critical care and reduce readmission rates to critical care. Although intuitively a good idea, there are few data to support outreach in terms of reducing the readmission rate to critical care and subsequent patient mortality. This retrospective observational study attempted to determine the change in the critical care readmission rate, an indicator of the quality of critical care, critical care mortality and in-hospital mortality following the introduction of a critical care outreach team in a major teaching hospital. METHODS: A retrospective review of 1380 discharges from critical care was undertaken and the readmissions identified (n = 176). Readmission rate, mortality and other demographic data were compared between the pre and post-outreach periods. RESULTS: Critical care mortality, in-hospital mortality and 30-day mortality were all reduced in the post-outreach period amongst readmissions to critical care. There was also a decease in the overall mortality of all patients admitted to critical care. There were no apparent causative factors for this reduction in mortality before and following outreach. CONCLUSIONS: There are many confounding factors in assessing the impact of outreach teams in hospitals. This study tentatively concludes that outreach teams may have a favourable impact on mortality rate amongst readmissions to critical care, but more data is needed from multicentre trials.

APACHE↗
PubMed2001

Anorexia nervosa and social class.

OBJECTIVES: (1) To examine social class status of female patients with anorexia nervosa presenting over a 33-year period; (2) to identify any differences in clinical features between the social classes. METHOD: Retrospective survey using comprehensive clinical database of patients referred to a national specialist center for the assessment and treatment of anorexia nervosa. Social class was defined using UK Registrar General's classification of father's occupation. Statistical methods included initial univariate analyses and subsequent ordinal logistic regression. RESULTS: (1) Social class distribution was consistently weighted toward social classes 1/2. (2) Possible clinical indicators examined included low body weight, binge eating, and consequent weight-regulatory behaviors such as vomiting and laxative and diuretic misuse. These clinical features and their distribution proved to be similar across the social groups. Clinically rated quality of family relationships and types of family constellations were also consistent across the social classes. (3) Dieting prodromata and onset of the disorder occurred at younger ages in social classes 1/2. (4) A modest shift in social class distribution over time was apparent, with slightly more patients presenting post-1985 likely to come from lower social classes. Claims that the social class distribution is a product of referral patterns and acceptances are disputed. CONCLUSION: We suggest that the social class bias reflects a sociocultural influence; a product of the disorder significantly often arising as an avoidant response to the conflict between social class-related family values/attitudes and adolescent turbulence within that family.

Adult↗
PubMed1995

The incidence and prevalence of anorexia nervosa in three suburban health districts in south west London, U.K.

OBJECTIVE: To determine incidence and prevalence of anorexia nervosa in a defined geographical area of south west London, UK, total population 519,900. METHOD: Hospital and community health workers in the defined area were contacted initially by letter asking them to identify all cases (new or existing) of anorexia nervosa known to them in the period July 1991-June 1992, using DSM-III-R criteria. A semistructured interview was conducted with the respondents to confirm the diagnosis. The large database record of the senior authors' specialist anorexia nervosa service, including inpatient and outpatient service records, was concurrently screened for cases living in the defined area. RESULTS: The prevalence of anorexia nervosa was found by this method to be 20.2 cases per 100,000 population (0.02% total population). Prevalence in females aged 15-29 years was 115.4 cases per 100,000 (0.1% of young females). Similarly, the annual incidence of anorexia nervosa was found to be 2.7 cases per 100,000 total population. In females aged 15-29 years the incidence was 19.2 cases per 100,000. DISCUSSION: Such prevalence and incidence figures are probably significant underestimates since the disorder can often defy detection or correct diagnosis and, with our own methodology, some identified cases may not have been reported to the study. However, these results can be used as a start for resource planning and service development.

Adolescent↗
PubMed1991

Sexual abuse, disordered personality and eating disorders.

Standardised personality assessments were administered to 50 consecutive referrals to an Eating Disorders Clinic. A history of childhood sexual abuse was identified in 30% of patients using a modified version of the SLEI. This rate is comparable with those from other studies. Overall, 52% of the patients were rated as having a personality disorder but a significantly higher proportion of women with a personality disorder had a history of childhood sexual abuse compared with those without a personality disorder (13/26 v. 2/24, Fisher P less than 0.001). Although in patients with eating disorders no clear causal link between CSA and personality disorder was demonstrated, our findings emphasise the need to inquire sensitively into the sexual history of such patients.

Adolescent↗
PubMed1979

Processing determinants of reading speed.

Two groups of university undergraduates differing in reading ability were tested on a number of reaction-time tasks designed to determine the speed of encoding visual information at several different levels. In addition, the subjects were given tests of sensory functions, verbal and quantitative reasoning ability, short-term auditory memory span, and ability to comprehend spoken text. The groups did not differ on the sensory tests. However, the faster reader group had faster reaction times on all of the reaction-time tasks, and the size of the fast-reader advantage increased with the mean reaction time. Faster readers also performed more accurately in verbal and quantitative reasoning, short-term auditory memory, and speech comprehension. Regression analyses suggested that the ability to comprehend spoken material and speed of accessing overlearned memory codes for visually presented letters represented two important independent correlates of reading ability in our sample of subjects. Two variables reflecting these abilities--the percentage of correct answers to a listening comprehension test and the reaction time for correct responses in a letter-matching task--accounted for nearly all of the variance in reading ability tapped by both of our reading tests. In a second experiment, no reaction-time difference was found between fast and average readers in a matching task requiring no long-term memory code access but considerable visual information processing as indexed by overall mean reaction time. The results supported the conclusion that one skill allowing fast readers to capture more information from each reading fixation is faster access to letter codes from print.

Concept Formation↗
PubMed1972

Trends in education.

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Delivery of Health Care↗