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Biomedical subjects

N Aslam

Publications and source records attributed to N Aslam.

At least 19 recordsLinked to original sources
PubMed2006

A comparative study of the risk of malignancy index and the ovarian crescent sign for the diagnosis of invasive ovarian cancer.

OBJECTIVE: To compare the value of the risk of malignancy index (RMI) and the ovarian crescent sign (OCS) in the diagnosis of ovarian malignancy. METHODS: This was a prospective observational study of women with ultrasonographic diagnosis of an ovarian cyst. The RMI was calculated in all cases using a previously published formula (RMI = U (ultrasound score) x M (menopausal status) x serum CA125 (kU/L)). A value > 200 was considered to be diagnostic of ovarian cancer. The OCS was defined as a rim of visible healthy ovarian tissue in the ipsilateral ovary. Its absence was taken as being diagnostic of invasive cancer. RESULTS: A total of 106 consecutive women were included in the study, of whom 92 (86.8%) had a benign ovarian tumor, five (4.7%) had borderline lesions and nine (8.5%) had an invasive ovarian cancer. The absence of an OCS diagnosed invasive ovarian cancer with a sensitivity of 100% (95% CI, 70-100%), specificity of 93% (95% CI, 86-96%), positive predictive value (PPV) of 56%, negative predictive value (NPV) of 100% and positive likelihood ratio (LR+) of 13.86 (95% CI, 6.79-28.29). This compared favorably with a sensitivity of 89% (95% CI, 57-98%), specificity of 92% (95% CI, 85-96%), PPV of 50%, NPV of 99% and LR+ of 10.78 (95% CI, 5.34-21.77), which were achieved using RMI > 200 (P < 0.01). CONCLUSIONS: The RMI and the OCS are useful tests for discriminating between invasive and non-invasive ovarian tumors. The application of these tests in a sequential manner might improve the overall accuracy of ovarian cancer diagnosis.

Algorithms↗
PubMed2006

Predictors of mortality in end-stage renal disease patients with mitral annulus calcification.

OBJECTIVE: Mitral annulus calcification (MAC) is an independent predictor of cardiovascular mortality in the general population. The purpose of the current historical cohort study is to assess risk factors for long-term mortality in end-stage renal disease (ESRD) patients with MAC (n = 30; age, 62 +/- 2 yr), as compared to ESRD patients without MAC (n = 30; age, 63 +/- 2 yr). Additional analysis compared ESRD patients with MAC to non-ESRD patients with MAC (n = 32; age, 66 +/- 2 yr). METHODS: The groups included age-matched male patients followed at a single center. Long-term survival was assessed by Kaplan-Meier analysis. Regular and stepwise Cox proportional hazards models were used to determine risk factors for mortality. RESULTS: There was a similarly high prevalence of cardiovascular complications, including hypertension, coronary artery disease, left ventricular hypertrophy, atrial fibrillation, and congestive heart failure, in all three groups. Median survival time was significantly longer in non-ESRD patients (90 months), compared with the ESRD with MAC (45 months) and ESRD without MAC (45 months) patients (log-rank test; P < 0.001). With stepwise Cox proportional hazards model, including ESRD patients with MAC and ESRD patients without MAC, increased calcium x phosphate product, decreased serum creatinine concentration, and the presence of coronary artery disease and lower extremity amputations were independent predictors of mortality for patients with ESRD. With stepwise Cox proportional hazards model, including ESRD patients with MAC and non-ESRD patients with MAC, the presence of ESRD, atrial fibrillation, diabetes, aortic valve calcification, coronary artery disease, and tricuspid regurgitation were independent predictors of mortality. CONCLUSION: The mortality rate was high in ESRD patients, approximately 15% per year. After accounting for baseline cardiovascular disease and traditional risk factors, the presence of MAC did not confer additional risk for mortality.

Calcinosis↗
PubMed2005

Mechanisms and pattern of facial lacerations in the Accident Department.

The purpose of this study was to determine patterns of facial laceration seen in the Accident and Emergency Department and identify how they are related to the mechanism of injury. A retrospective analysis of facial lacerations of an adult presenting to Accident and Emergency department was made over a 6-month period. There were 197 consecutive facial lacerations. The mean age of patients was 46 years. There were 137 male and 60 female patients. The aetiology of lacerations was falls (48%), assaults (11%), hit by an object by accident (21%) and hit stationary object by accident (15%). Mechanism of injury was found to be related to common patterns of laceration. Lacerations affecting the forehead mainly occurred in falls and those affecting the peri-orbital and peri-oral areas in assault. Lacerations were mainly linear, with a mean length of 2.4 cm, and about 75% were precipitated by blunt injury. Identification of common patterns of injury corresponding to a certain mechanism may allow assessment of the difficult or non-compliant patient. Understanding mechanisms of injury will allow safety planners to design safer domestic and workplace environments.

Accidental Falls↗
PubMed2005

Iliofemoral distraction and hip reconstruction for the sequelae of a septic dislocated hip with chronic femoral osteomyelitis.

We describe a technique of 'cross-hip distraction' to reduce a dislocated hip with subsequent reconstruction of the joint for septic arthritis with extensive femoral osteomyelitis. A 27-year-old woman presented with a dislocated, collapsed femoral head and chronic osteomyelitis of the femur. Examination revealed a leg-length discrepancy of 7 cm and an irritable hip. A staged technique was used with primary clearance of osteomyelitis and secondary reconstruction of the hip. A cross-hip monolateral external fixator was used to establish normal anatomy followed by an arthroplasty. A good functional outcome was achieved. The use of cross-hip distraction avoids soft-tissue and nerve damage and achieved improved abductor function before arthroplasty.

Adult↗
PubMed2005

The effects of hyaluronic acid on articular chondrocytes.

The purpose of this study was to examine the effects of hyaluronic acid supplementation on chondrocyte metabolism in vitro. The clinical benefits of intra-articular hyaluronic acid injections are thought to occur through improved joint lubrication. Recent findings have shown that exogenous hyaluronic acid is incorporated into articular cartilage where it may have a direct biological effect on chondrocytes through CD44 receptors.Bovine articular chondrocytes were isolated and seeded into alginate constructs. These were cultured in medium containing hyaluronic acid at varying concentrations. Samples were assayed for biochemical and histological changes. There was a dose-dependent response to the exposure of hyaluronic acid to bovine articular chondrocytes in vitro. Low concentrations of hyaluronic acid (0.1 mg/mL and 1 mg/mL) significantly increase DNA, sulphated glycosaminoglycan and hydroxyproline synthesis. Immunohistology confirmed the maintenance of cell phenotype with increased matrix deposition of chondroitin-6-sulphate and collagen type II. These findings confirm a stimulatory effect of hyaluronic acid on chondrocyte metabolism.

Animals↗
PubMed2004

The value of detection of normal ovarian tissue (the 'ovarian crescent sign') in the differential diagnosis of adnexal masses.

OBJECTIVE: The aim of the study was to evaluate whether the presence of normal ovarian tissue adjacent to an adnexal tumor (the 'ovarian crescent sign') could assist in the preoperative differential diagnosis of adnexal lesions. METHODS: This was a prospective observational study including 100 women with a preoperative diagnosis of an adnexal mass. Demographic and biochemical data were collected and all women underwent a detailed transvaginal ultrasound scan. Tumor volume, morphological characteristics and Doppler features were recorded in each case. In addition, the tissue adjacent to the cyst was systematically examined for the presence of normal ovarian tissue. All the findings were compared to the final histological diagnosis. RESULTS: Sixty-seven (67%) of the cysts removed were benign, nine (9%) were borderline and 24 (24%) women had invasive malignant lesions. Normal ovarian tissue was seen in 58/76 (76%) women with non-invasive lesions, and in one woman (4%) with an invasive malignancy. In the absence of normal ovarian tissue, ovarian cancer was diagnosed with a sensitivity of 96% and specificity of 76%. CONCLUSION: The presence of normal ovarian tissue adjacent to an ovarian cyst is a useful morphological feature that may be used to help exclude an invasive ovarian malignancy in women with adnexal masses detected on ultrasound scan.

Adnexal Diseases↗
PubMed2004

Snowdome, skiers and boarders: accident and emergency experience.

A prospective case series was compiled of all people presenting to the accident and emergency department with an injury caused by snowboarding or skiing, during the first year of opening of the Milton Keynes snowdome. The aim was to analyse the types of injuries associated with recreational snowboarding and to compare these with the injuries seen in skiing. Of the snowboarders, 23 (86%) were males, and the mean age was 24 years. Of the skiers, 13 (81%) were males, and the mean age was 34 years. Forty-three injuries required orthopaedic review, and 12 were admitted for further management. Significant differences were noted between the patterns of injuries in snowboarding and skiing. The snowboarders had a higher incidence of upper limb injuries (96 vs. 62%) and a lower incidence of lower limb injuries (4 vs. 38%) compared to the skiers. This study demonstrates that the opening of a leisure facility has a significant impact on the local accident and emergency department. Snowboarding is associated with a unique pattern of injuries, the knowledge of which should influence education and accident prevention.

Adolescent↗
PubMed2004

Regional audit: perioperative management of MRSA orthopaedic patients in the Oxford region.

AIM: Methicillin resistant staphylococcus aureus (MRSA) colonisation or infection is of particular importance in patients undergoing operations involving implantable materials, such as in orthopaedic surgery. An audit of the perioperative management of orthopaedic patients in the Oxford region was carried out to assess the level of clinician awareness and the uniformity of current guidelines between hospitals. METHODS: A postal questionnaire was designed for asking information on various aspects of perioperative management of MRSA patients and was sent to each hospital. RESULTS: Responses were obtained from nine of 10 hospitals in the region. The average response rate for each hospital was 75%, and the overall individual response rate was 67.5% (27/40). Seventy-eight per cent of respondents knew that there was a pre-admission screening policy. Fifteen per cent were unaware of any MRSA policy. Forty-four per cent indicated that teicoplanin was used for prophylaxis in implant surgery whilst 44% used vancomycin. Eighteen per cent believed that cefuroxime was used for prophylaxis. Forty-eight per cent of hospitals had an MRSA-free zone for orthopaedic patients. CONCLUSION: This study indicates a lack of uniformity in the perioperative management of MRSA-positive patients in the region and a lack of awareness of both MRSA guidelines and their implementation. Uniformity of MRSA guidelines is necessary to allow better clinician awareness and compliance, especially in surgical trainees who are travelling between different training hospitals in the region. Implementation of such a policy with re-audit of subsequent awareness and compliance is proposed.

Antibiotic Prophylaxis↗
PubMed2003

Multiple schwannomas of the median nerve: a case report and literature review.

We report a case of multiple schwannomas of the median nerve. Multiple schwannomas can be difficult to diagnose on clinical grounds and can be mistakenly diagnosed as carpal tunnel syndrome or ganglia as in our case. Nerve conduction studies helped locate non-visible tumours. Magnetic resonance imaging (MRI) is useful in the preoperative planning of these tumours. The appearances on scanning however can be sometimes confused for ganglia as in this case. Intraneural dissection of the schwannomas was carried out and the pathology is described.

Adult↗
PubMed2003

The impact of implementing the Ottawa ankle rules on ankle radiography requests in A&E.

This audit was set up to quantify the effect of implementing the Ottawa ankle rules in a district general hospital that relies on both medical and nursing radiography requests. Data were collected prospectively on 207 patients who presented with an acute ankle injury between August 2001 and February 2002. The department's activity was recorded before and after a period of teaching on the Ottawa ankle rules. Before teaching, 71% of patients with an acute ankle injury were sent for radiography; teaching reduced this figure to 56% (p < 0.05). Auditing the activity of our department enabled us to observe a significant decrease in the number of patients sent for ankle radiography following acute ankle injury. This correlates well with research in other settings. The difficulties of rationalising radiology investigations are discussed.

Adolescent↗
PubMed2001

Expectant management of early pregnancies of unknown location: a prospective evaluation of methods to predict spontaneous resolution of pregnancy.

OBJECTIVE: To assess prospectively the ability of two multiparameter diagnostic models and their individual components to predict the outcome of early pregnancies which could not be identified on transvaginal ultrasound scan. DESIGN: Prospective observational study. SETTING: Dedicated early pregnancy unit in an inner city teaching hospital. POPULATION: Women with a positive urine pregnancy test and clinical suspicion of early pregnancy complications. METHODS: A full medical history, clinical examination and transvaginal ultrasound scan were carried out at the initial visit. When the location of the pregnancy could not be ascertained by ultrasound, serum beta-human chorionic gonadotrophin (beta-hCG) and progesterone levels were measured. All women were managed expectantly until either a normal pregnancy was visualised on scan; the pregnancy resolved spontaneously or intervention was required due to a worsening of clinical symptoms or non-declining beta-hCG levels. MAIN OUTCOME MEASURES: Spontaneous resolution of pregnancy (i.e. cessation of symptoms and decline in serum beta-hCG level to < 20 iu/L) without need for any active intervention. RESULTS: Of the 104 women recruited, 72 (69%) pregnancies resolved spontaneously. Both multiparameter diagnostic models identified resolving pregnancies with positive predictive values > or = 95%. Their performances were not significantly better compared with individual progesterone levels which achieved a positive predictive value of 97% using a cutoff level of 20 nmol/L. CONCLUSION: Serum progesterone measurement alone is as accurate as more complex diagnostic models for the prediction of successful expectant management in pregnancies of unknown location.

Abortion, Spontaneous↗
PubMed2000

Prospective evaluation of logistic regression models for the diagnosis of ovarian cancer.

OBJECTIVE: To test the accuracy of three logistic regression models in diagnosing malignancy in women with adnexal masses. METHODS: This was a prospective collaborative study. Women were recruited from three hospitals and all assessments were performed at the Gynaecology Ultrasound Unit, King's College Hospital. One hundred women with known adnexal masses were examined preoperatively. The demographic, biochemical, and sonographic data recorded for each patient included age, menopausal status, CA 125 levels, ultrasound morphology, and Doppler blood flow analysis. The diagnosis of malignancy was made for each woman using three logistic regression models previously described by Alcazar et al, Tailor et al, and Timmerman et al. Variables used in these models were then combined to form a new model. The results were compared with the final histopathologic diagnosis. RESULTS: Sixty-seven women had benign tumors and 33 had ovarian cancer. Women with malignant tumors were older than those with benign masses. There were significant differences in CA 125 levels, presence of papillary proliferations, and ascites between the two groups. The sensitivities and specificities achieved respectively by the models were as follows: 45% and 93% with Tailor et al's model, 9% and 99% with Alcazar et al's model, and 73% and 91% with Timmerman et al's model. There was no significant improvement over the performance of Timmerman et al's model and the new combined model. CONCLUSION: All models performed less well than originally reported. Combining the models did not lead to a significant improvement in performance. Larger sample sizes that incorporate all types of ovarian tumors are necessary to design more accurate diagnostic models.

Adult↗
PubMed2000

Prospective evaluation of three different models for the pre-operative diagnosis of ovarian cancer.

OBJECTIVE: To test the accuracy of the risk of malignancy index, the revised risk of malignancy index and Tailor's regression model to diagnose malignancy in women with known adnexal masses. DESIGN: Prospective collaborative study. SETTING: Gynaecology Assessment Unit, Department of Obstetrics and Gynaecology, King's College Hospital, London. SAMPLE: Sixty-one women with known adnexal masses were examined pre-operatively. Women were recruited from three South London hospitals. METHODS: The demographic, biochemical and sonographic data recorded for each patient included: age; menopausal status; CA125 levels; tumour volume; ultrasound characteristics; and Doppler blood flow analysis (peak and mean blood velocities, the pulsatility and resistance indices). The diagnosis of malignancy was made for each woman using all three models and the results compared with the final histopathological diagnosis. RESULTS: Thirty-eight women had benign tumours and 23 had ovarian cancer. Women with malignant tumours were significantly older than those with benign masses. There were also significant differences in CA125 levels, locularity, presence of papillary proliferations and ascites between the two groups. Tailor's regression model achieved a 43% sensitivity and 92% specificity in the diagnosis of malignancy. This compared with a 74% sensitivity and 92% specificity with the risk of malignancy model, and a 74% sensitivity and 89% specificity with the revised risk of malignancy model. CONCLUSION: When applied prospectively all three diagnostic models performed less accurately than originally reported, despite clinical signs of malignancy being present in many cases. It is likely that their accuracy would be even less in a population of women in whom there was a substantial clinical uncertainty. Intra-tumoral blood velocity and CA125 levels were the best individual parameters for discrimination between benign and malignant tumours.

Adult↗
PubMed2000

Serum CA125 at 11-14 weeks of gestation in women with morphologically normal ovaries.

In a number of pregnant women ovarian cysts are found incidentally during the routine first trimester scan. These cysts may pose diagnostic difficulties, and the measurement of serum CA125 levels can be used to aid management. In this study we measured maternal serum CA125 levels in 188 women with uncomplicated pregnancies between 11-14 weeks of gestation. All women had morphologically normal ovaries observed on ultrasound examination. The median serum CA125 levels were 23.4 U/mL (range 2.2-166.3 U/mL, 95% reference interval 5.28-70.15) and did not change significantly with gestation. We conclude that CA125 levels are increased at 11-14 weeks of gestation and cut off values which are used to assess the nature of ovarian cysts in nonpregnant women cannot be applied to pregnant women at this gestation.

Adolescent↗
PubMed2000

Nephrotic syndrome in chronic lymphocytic leukemia: a paraneoplastic syndrome?

The association of malignancy and various glomerulopathies is a well recognized phenomenon. We report a case of nephrotic syndrome secondary to minimal-change disease in a patient with chronic lymphocytic leukemia (CLL) and review the literature on nephrotic syndrome in this disorder. Since the relative distribution of etiologies differ from what might be expected for primary nephrotic syndrome in a similar aged population, we propose that nephrotic syndrome is a potential paraneoplastic phenomenon associated with CLL. We hypothesize a possible etiologic role of different cell surface markers of the lymphocyte to explain the diverse renal histologic manifestations.

Aged↗
PubMed1999

The effectiveness of non-surgical management of early interstitial pregnancy: a report of ten cases and review of the literature.

OBJECTIVE: To assess the effectiveness of non-surgical management of interstitial pregnancy. DESIGN: A prospective interventional study. SUBJECTS: Eleven women with the ultrasound diagnosis of interstitial ectopic pregnancy. METHODS: Women with suspected early pregnancy complications were examined by transvaginal ultrasound. Those with the diagnosis of interstitial pregnancy were offered non-surgical treatment with methotrexate, which was administered systemically or by local injection. Follow-up with regular measurements of beta-human chorionic gonadotropin and ultrasound scans continued until the pregnancy had resolved completely. RESULTS: Ten women were managed non-surgically, and one woman opted for surgery. Five women received systemic and five local methotrexate. Local therapy was successful in all five cases (100%), whereas four out of five (80%) women receiving systemic methotrexate were cured. Significant side-effects were noted in two women following systemic therapy. In comparison, there were no side-effects in the group of women who received local therapy. There were no significant differences between the two treatment groups in the length of time taken for the pregnancy to resolve. CONCLUSIONS: Non-surgical treatment of interstitial pregnancy with methotrexate appears to be safe and effective. Local administration appears to be more successful and better tolerated by patients and may be used as the first-line therapy.

Abortifacient Agents, Nonsteroidal↗