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Biomedical subjects

M Beirne

Publications and source records attributed to M Beirne.

11 recordsLinked to original sources
PubMed2001

An audit of ambulatory cassette EEG monitoring in children.

This audit evaluated the role and usefulness of ambulatory cassette EEG recordings without simultaneous video monitoring in children with paroxysmal episodes including epilepsy. Fifty-four children underwent ambulatory EEG recordings for 48 hours over a 12 month period. Only 31 of the 54 children experienced one of their typical clinical episodes during their recordings. Fifteen of these 31 patients were considered to have epilepsy, only three of whom had a clinical episode at the time of their recording and in all three the EEG demonstrated abnormal (generalized spike and slow wave or focal, rhythmic slow wave) activity. All 10 patients who were considered to have non-epileptic episodes showed no electrical change during their EEG recordings. The results of the ambulatory cassette EEG recordings were considered to have been helpful and to have contributed to the management of only 17 (31%) of the 54 patients in this audit. Stricter clinical criteria for undertaking ambulatory recordings and improved technology are likely to increase the role and usefulness of this procedure.

Adolescent↗
PubMed2001

Outlet strut fracture of Björk-Shiley convexo-concave valves: can valve-manufacturing characteristics explain the risk?

BACKGROUND: Björk-Shiley 60 degrees convexo-concave prosthetic heart valves (Shiley, Inc, Irvine, Calif, a subsidiary of Pfizer, Inc) continue to be a concern for approximately 35,000 nonexplanted patients worldwide, with approximately 600 events reported to the manufacturer to date. Fractures of the outlet struts of the valves began to appear in the early 1980s and have continued to the present, but their causes are only partially understood. METHODS: A matched case-control study was conducted evaluating manufacturing records for 52 valves with outlet strut fractures and 248 control subjects matched for age at implantation, valve size, and valve position. RESULTS: In addition to the risk factors recognized as determinants of outlet strut fracture, the United Kingdom case-control study has observed 7- to 9-fold increased risk with performance of multiple hook deflection tests. This test was performed more than once, usually after rework on the valve. Six valves in this study underwent multiple hook deflection tests, of which 4 experienced an outlet strut fracture. Cracks and further rework were noted for these valves. Significant associations were also observed between outlet strut fracture and disc-to-strut gap measurements taken before the attachment of the sewing ring. CONCLUSIONS: It is our view that a combination of factors related to valve design, manufacturing process, and patient characteristics are responsible for outlet strut fractures of Björk-Shiley convexo-concave valves. Multiple hook deflection tests have emerged as a potential new risk factor for outlet strut fracture in both The Netherlands and the United Kingdom. This factor appears to be correlated with the presence of other abnormalities. A further study is needed to investigate the factors correlated with multiple hook deflection tests. On confirmation of risk, the presence of multiple hook deflection tests may be added to equations, quantifying the risk of outlet strut fracture for comparison against risk of mortality and serious morbidity from explant operations.

Analysis of Variance↗
PubMed2000

Photosensitivity in juvenile myoclonic epilepsy.

Photosensitivity is reported to occur in approximately 40% of patients with juvenile myoclonic epilepsy. Our experience suggests that the prevalence is higher and may be related to both the duration of intermittent photic stimulation and also the age at which the procedure is undertaken. A two-year retrospective review of all EEGs was undertaken on all children attending a paediatric EEG department to identify those with juvenile myoclonic epilepsy. Photosensitivity was defined as a generalized spike or spike-wave paroxysm occurring at least twice during intermittent photic stimulation. Sixty-one children with a diagnosis of juvenile myoclonic epilepsy with a median age of 13 (range 7-16) years were identified, 55 (90%) of whom were photosensitive. Eighteen of these 55 patients showed photosensitivity only after four minutes of continuous photic stimulation. The prevalence of photosensitivity in juvenile myoclonic epilepsy is likely to be higher than previously reported. When a diagnosis of juvenile myoclonic epilepsy is being considered, the initial diagnostic EEG should include intermittent photic stimulation for up to five minutes, or less if the patient shows evidence of photosensitivity. The identification of photosensitivity may have important management implications.

Adolescent↗
PubMed2000

Incomplete and inaccurate death certification--the impact on research.

BACKGROUND: The objectives of this study were (1) to investigate the extent of erroneous and/or omitted information on death certificates of patients-implanted with Bjork-Shiley Convexo-Concave (BSCC) heart valves; (2) to determine whether this information could be associated with a possible under-reporting of acute mechanical failure of this valve. METHODS: A review was carried out of death certificates and clinical notes for patients implanted in the United Kingdom with BSCC valves. This was a multicentre study (38 hospitals) based at the Cardiothoracic Department, NHLI, Imperial College School of Medicine at Hammersmith Hospital, London. The subjects were 478 patients implanted with a BSCC valve between 1979 and 1986 who died in the following years: 1984, 1987, 1990, 1993 and 1996. The main outcome measures were: (1) percentage of death certificates that record the presence of a valve prosthesis; (2) percentage of death certificates that record the presence of a valve prosthesis for patients who had a post mortem; (3) percentage of death certificates that record inaccurate or incomplete information related to the surgery; (4) percentage of death certificates that do not record a post mortem where one is known to have been performed. RESULTS: Twenty-one per cent (101/478) of the total number of death certificates record the presence of the valve prosthesis. Thirty-five per cent (43/123) of the death certificates for patients who had a post mortem record the presence of a valve prosthesis. Six per cent (30/478) of death certificates report inaccurate information related to the valve surgery. Twenty-five per cent (118/478) of the total number of death certificates recorded a single cause of death. Twenty-three per cent (110/478) of all death certificates reviewed recorded only the mode of dying. Eight per cent (10/123) of the total number of death certificates for patients who had a post mortem did not record a post mortem. CONCLUSIONS: The relatively high number of death certificates that do not record the presence of a valve prosthesis and the observed under-reporting of post mortems may lead to inaccurate reporting of the number of BSCC valves that fail. Previous recommendations to improve accuracy in death certification appear to have gone unheeded, and changes in the way certificates are completed for patients with implanted cardiac devices should be considered.

Aged↗
PubMed1996

Clinicians' vs. technicians' history when obtaining an EEG.

The practical value or usefulness of any investigation is dependent upon the clinical information provided and subsequent interpretation; this is particularly important in the investigation and classification of the epilepsies. For two months the histories from clinicians and EEG technicians were prospectively evaluated from 255 consecutive patients. The histories were interpreted by a single paediatric neurologist who was blinded to their origin. The histories were reported as "adequate' or "inadequate', and "diagnostic' or "non-diagnostic' (of epilepsy). Overall 92% and 40% of technicians' and 41% and 13% of clinicians' histories were considered to have been "adequate' and "diagnostic', respectively. These results have implications for the electro-clinical interpretation of the EEG.

Adolescent↗
PubMed1996

Absence epilepsy in children: the role of EEG in monitoring response to treatment.

We report the use of repeat electroencephalography (EEG) in the management of 69 patients with childhood-onset absence epilepsy (CAE). Electro-clinical absences were demonstrated in seven children who were felt clinically to have persisting absences. In three of the remaining 62 patients who were thought to be seizure-free, repeat EEG showed electro-clinical absences; revision of AEDs in these three children resulted in clinical and EEG control. EEG is a useful adjunct to the (usual) subjective monitoring of the response to treatment, and should be repeated routinely in all patients with CAE.

Anticonvulsants↗
PubMed1995

EEG requests in paediatrics: an audit.

An audit of 165 requests for electroencephalography (EEG) was undertaken before and after the introduction of guidelines and recommendations, 12 months apart. Inadequate clinical information was provided in requests in both surveys; 40% of requests were considered to be unnecessary, and approximately 50% of clinicians felt that EEG could diagnose epilepsy.

Adolescent↗
PubMed1993

Eyelid myoclonia with typical absences: an epilepsy syndrome.

Five unrelated patients are described with the clinical and electrical features of eyelid myoclonia with absences (EMA). In this syndrome brief, typical absences occur with rapid eyelid myoclonia associated with retropulsive movements of the eyeballs and occasionally of the head. The seizures are of shorter duration than in childhood absence epilepsy, and are accompanied by less profound impairment of consciousness. The electroencephalogram demonstrates high amplitude discharges consisting of spikes, multiple spikes and slow waves at a fluctuating frequency of 3-5 Hz and following eye closure, which disappear in darkness. Photosensitivity is also seen. Onset is in early childhood and EMA appears to persist into adult life. Treatment is sodium valproate in combination with either ethosuximide or a benzodiazepine. On the basis of the clinical features, EEG findings, and the response to treatment and prognosis, it is suggested that EMA be classified as a specific epilepsy syndrome.

Adolescent↗
PubMed1993

Focal electroencephalographic abnormalities and computerised tomography findings in children with seizures.

A persistent focal abnormality was observed in 157 (16%) electroencephalograms undertaken in 964 consecutive children with epileptic and non-epileptic seizures seen over one year. CT head scans were performed in 121 (77%) of the 157 children with a focus on the EEG; 26 (21%) showed an abnormality, and 21 (81%) of the abnormalities were localised. There was no difference in the proportion of abnormal scans associated with a delta or slow wave focus compared with a spike or sharp wave focus. An abnormal scan was uncommon after a single seizure. In only two patients (1.7% of all scans) did the findings on CT alter or greatly influence subsequent management.

Adolescent↗