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Biomedical subjects

M J Bradley

Publications and source records attributed to M J Bradley.

At least 19 recordsLinked to original sources
PubMed2006

A prospective assessment of carpal tunnel surgery with respect to age.

Six hundred and thirty five carpal tunnel decompressions in 490 patients were studied prospectively in two hand surgery centres to assess the effect of increasing age on the outcome after surgery. The outcome was assessed using the Levine-Katz carpal tunnel questionnaire, Tinel's sign, Phalen's test, Semmes-Weinstein monofilaments and pinch and grip strengths. Assessments were made pre-operatively, at 2 weeks and 6 months postoperatively. Information was also sought concerning co-morbid conditions. Cases were divided into four groups (less than 40 years of age, 40 to 60, 61 to 80, and over 80 years of age). Patients improved significantly in all age groups after carpal tunnel surgery. Despite a relatively high number of co-morbidities, older patients had an acceptable complication rate and their improvement was comparable to all other age groups.

Adult↗
PubMed2004

Carpal tunnel syndrome and work.

The incidence, age at presentation, disability and outcome after surgery were investigated in 327 consecutive women of working age presenting to a hand unit with carpal tunnel syndrome. Two hundred and seventeen were working, 55 of these in repetitive occupations. One hundred and ten were not in employment. All three groups had similar mean ages (around 46 years). On a population basis more women in non-repetitive occupations presented with carpal tunnel syndrome (220/100,000/year) than those in repetitive work (122/100,000/year) or those not working (129/100,000/year), and more were offered surgery (82% versus 67% for those in repetitive work and 58% for those not working). However, symptoms and disability; as assessed with the Michigan Hand Questionnaire and the SF-12, were less severe in working women. This study suggests that working in repetitive or non-repetitive occupations does not cause, aggravate or accelerate carpal tunnel syndrome. Working women may struggle to accommodate their symptoms compared to women who are not in employment causing more to seek help.

Adult↗
PubMed2004

Providing care for hand disorders a re-appraisal of need.

An audit of hand surgery activity in Derby during the period 1989-1990 produced manpower and resource recommendations for the speciality per 100,000 of population per year for the United Kingdom. The decade that followed the audit has seen major changes in health care provision, including reduced service activity by trainee doctors through restricted hours of work and less unsupervised surgery. A further audit of hand surgery activity was performed during 2000-2001 to assess the effects of these and other changes. This showed that there has been a 2% rise in trauma attendances, though trauma bed utilization had reduced by 12% and surgery time by 38%. Trauma out-patient visits had also reduced by 11%. Day-case trauma surgery rates were virtually unchanged at 63%. Women attend more frequently with traumatic hand injuries than they did 10 years ago and there is a rising incidence of hand injuries in the home, with a falling incidence at work. Elective referrals have risen by 36% and operations by 34%. The top ten diagnoses relate to the same conditions although their rankings have changed. Elective day-case surgery rates have risen from 64% to 94% over the decade. The 34% increase in elective operations has been absorbed within a 5% reduction in elective bed use and a 23% reduction in surgery time. Elective out-patient visits have also dropped 14% overall. This audit indicates that in 2000-2001 one whole time equivalent hand surgeon can service a population of 125,000. The national requirement for a 56 million population would be 448 whole time equivalent hand surgeons.

Adolescent↗
PubMed2003

Primary care referral protocol for wrist ganglia.

The paper summarises current knowledge on ganglia of the wrist including the views of patients and doctors. The efficacy of available treatment options are discussed. Summary points are derived from the available knowledge with a referral protocol from primary care.

Attitude of Health Personnel↗
PubMed2003

Primary care management of carpal tunnel syndrome.

Carpal tunnel syndrome of mild to moderate severity can often be effectively treated in a primary care environment. Workplace task modification and wrist splints can reduce or defer referral to hospital for surgical decompression. Nerve and tendon gliding exercises may also be of benefit. Steroid injections to the mouth of the carpal tunnel are particularly useful for symptomatic women in the third trimester of pregnancy. However inadvertent neural injection may cause disabling chronic pain. Referral to a minority of practitioners trained in the technique would ensure sufficient patient numbers to maintain skill levels.

Carpal Tunnel Syndrome↗
PubMed2002

Characterization of guided microwave spectrometry using water-ethanol mixtures.

On-line measurement of food composition plays an important role in ensuring good quality control during processing operations. Microwave based instruments provide on-line measurement of the bulk sample due to the relatively long wavelength. Characterization of Guided Microwave Spectrometry (GMS) was conducted in this study. The GMS spectra and dielectric properties of water-ethanol mixtures with ethanol contents (v/v) of 0, 25 and 50% were measured at 10 degrees C, 23 degrees C and 40 degrees C. The effects of coaxial cables and antenna were examined and the detection limits of the GMS analyzer were determined. The dielectric properties of the material being measured affected the GMS spectrum by shifting the cutoff region and changing the spectral amplitude over the entire operating frequency span. Temperature affected the spectrum by changing the dielectric properties of the material. Coaxial cables did not have a significant effect on the spectrum and the characteristic dip in the passband region was due to antenna resonance. The antenna affected the number of the resonances present in the spectrum, the frequency location and the amplitude of the resonances. GMS system has both a lower and upper amplitude limit beyond which its resolution decreases significantly. This can be resolved by using a signal attenuator and a smaller sensor body.

Journal Article↗
PubMed2002

Primary care referral protocol for carpal tunnel syndrome.

Carpal tunnel syndrome is an extremely common upper limb nerve compression syndrome, widely distributed in the community. There are a variety of treatment options which may be applied to the syndrome, depending on the severity of symptoms. Some options are available in a primary care setting, others require secondary referral. This paper is a detailed review of the available literature and provides a protocol that could be used to assist in the referral of patients from primary care.

Carpal Tunnel Syndrome↗
PubMed2001

An in-vitro study to understand successful free-hand ultrasound guided intervention.

AIMS: To describe the optimum conditions for successful free-hand ultrasound guided intervention using an in-vitro experiment. MATERIALS AND METHODS: Optimal free-hand biopsy conditions were determined using targets buried in a purpose-built interventional phantom. The needle/probe distance and probe/phantom surface angle were changed whilst recording the needle track lengths and needle conspicuity. RESULTS: Optimal free-hand conditions included a needle/probe distance of 2-3 cm in combination with a needle/probe angle 55-60 degrees. This enabled excellent needle conspicuity with short needle track length and early needle tip visualization. CONCLUSION: Understanding how to optimize the free-hand conditions will help the interventionalist to obtain greater performance using a variety of puncture devices. This concept is likely to be particularly important to the novice interventionalist as well as to those teaching the free-hand technique.

Biopsy, Needle↗
PubMed2000

The role of colour flow Doppler in the investigation of the salivary gland tumour.

AIMS: Ultrasound is a highly effective imaging technique to determine salivary gland tumours and may help to identify many benign lesions. The aim of this study is to evaluate whether colour Doppler is able to further differentiate the malignant tumour. METHODS: Fifty-six patients with salivary gland lesions were prospectively assessed using ultrasound imaging with colour flow and power Doppler. The peak systolic velocity (PSV) was measured and the pulsatility index (PI) and resistive index (RI) calculations were performed on the pulsed wave traces. The real time ultrasound morphology and the Doppler information were correlated with the histology. RESULTS: In 18 of the 56 patients, no internal colour flow or power Doppler changes could be detected. The real time ultrasound morphology diagnosed benign disease with sensitivity of 89.7% with specificity of 57.1%. The positive predictive value was 93.6%. There were no significant differences in the colour Doppler appearances in terms of vessel type or intratumour distribution which could separate benign from malignant conditions. However, there was statistical discrimination for PI and RI values (P = 0.0006, P = 0.0002, respectively). No malignant lesions were seen when the PI was less than 1.8 and RI was less than 0.8. The PSV was elevated in several cases (> 50 cm per s) but there was no statistical correlation with malignancy. CONCLUSION: The risk of malignancy increases by a third when the colour Doppler demonstrates increased intratumour vascular resistance (RI > 0.8 and PI > 1.8), with positive predictive value of 97.3% (sensitivity 75.5%, specificity 85.7%).Bradley, M. J. (2000). Clinical Radiology55, 759-762.

Adult↗
PubMed1998

Evidence for the involvement of Fas ligand and perforin in the induction of vascular leak syndrome.

Endothelial cell injury resulting in vascular leak syndrome (VLS) is one of the most widely noted phenomenons in a variety of clinical diseases. In the current study we used IL-2-induced VLS as a model to investigate the role of cytolytic lymphocytes in the cytotoxicity of endothelial cells. Administration of IL-2 (75,000 U/mouse, three times a day for 3 days) into BL/6 wild-type mice triggered significant VLS in the lungs, liver, and spleen. Interestingly, perforin-knockout (KO) mice exhibited a marked decrease in IL-2-induced VLS in all three organs tested. Also, Fas ligand-defective (gld) mice and Fas-deficient (lpr) mice exhibited decreased VLS in the liver and spleen, but not in the lungs. The decreased VLS seen in perforin-KO, gld, and lpr mice was not due to any defect in lymphocyte migration or homing to various organs because histopathologic studies in these mice demonstrated significant and often greater perivascular infiltration of lymphocytes compared with the IL-2-treated wild-type mice. Ultrastructural studies of the lungs demonstrated significant damage to the endothelial cells in IL-2-treated wild-type mice and decreased damage in perforin-KO mice. IL-2 administration caused up-regulation of CD44 in all strains of mice tested and triggered increased LAK activity against an endothelial cell line in wild-type and gld mice, but not in perforin-KO mice. The current study demonstrates for the first time that perforin and Fas ligand may actively participate in endothelial cell injury and induction of VLS in a variety of organs.

Animals↗
PubMed1995

The role of venous colour flow Doppler to aid the non-diagnostic lung scintigram for pulmonary embolism.

Sixty patients admitted with a clinical diagnosis of pulmonary embolism underwent a prospective analysis of the value of lung ventilation/perfusion scintigraphy and lower limb colour flow venous Doppler. Twenty-two per cent of scintigrams gave a high probability of pulmonary embolus (PE) and 45% a low probability/normal. The remainder were classed as indeterminate scintigrams (33%) and of these, 55% showed leg thrombi on the ultrasound scan. These patients were therefore treated by anticoagulation. A small number of the low probability scintigrams also proved to have lower limb thrombi by ultrasound. As a result of these two investigations just over half of these patients with a clinical diagnosis of PE were anticoagulated (31 out of 60). In 62% of these the ultrasound suggested thrombi confined to the calf as a source of PE.

Algorithms↗
PubMed1995

Outcomes of hand surgery. British Society for Surgery of the Hand.

The findings are presented of a conference on Outcomes of Hand Surgery organized by the audit committee of British Society for Surgery of the Hand in 1993. Measures of outcome in terms of movement, power, sensibility, pain, activities of daily living, complications and patient satisfaction are considered, and an example of a patient evaluation measure given as an appendix.

Adult↗