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Biomedical subjects

P G Walker

Publications and source records attributed to P G Walker.

5 recordsLinked to original sources
PubMed1992

Comparison of cervical cytology and the polymerase chain reaction for HPV 16 to identify women with cervical disease in a general practice population.

A comparison of the ability of cervical cytology and the polymerase chain reaction (PCR) for human papilloma virus type 16 (HPV 16) to identify women with cervical disease has been performed in a general practice population of 249 women, none of whom were believed to have current cervical disease prior to examination. Within this population, 29 women were found by colposcopy and subsequent histopathology to have evidence of cervical disease [5 with cervical intraepithelial neoplasia (CIN) 3; 8 with CIN 2; and 16 with CIN 1]. The prevalence of HPV 16 in this population was 18.9% (CIN 3, 80%; CIN 2, 50%, CIN 1, 12.5%, normal, 16.8%). Women with severe disease (CIN 2 and CIN 3) had a significantly higher incidence of HPV 16 DNA than those with mild cervical disease (CIN 1) or no cervical abnormality (P = 0.001). There was no significant difference in the ability of either PCR for HPV 16 or cytology to identify women with cervical disease. The combination of screening by cytology and the presence of HPV 16 DNA resulted in the identification of a higher proportion of the women with disease, but this observation did not reach statistical significance. Although the failure to detect disease by the two screening methods was similar, HPV 16 DNA positivity was associated with a higher false-positive rate for disease detection than cytology (P less than 0.03). The PCR assay for detecting HPV 16 in this investigation was shown to have a false-positive rate of 2.4% and a false-negative rate of 10.4%. The prospect of screening women for cervical disease using PCR for HPV 16 is discussed.

Adolescent↗
PubMed1992

In vitro pulsatile flow hemodynamics of five mechanical aortic heart valve prostheses.

In vitro measurements of velocity, turbulent shear stress, effective orifice area (EOA), and regurgitant fraction were performed on five new-generation low-profile mechanical aortic heart valve designs under pulsatile flow conditions. These were: Medtronic-Hall tilting disc, St. Jude Medical bileaflet, Björk-Shiley Monostrut tilting disc, Omni-Carbon tilting disc, and Duromedics bileaflet. In general, bileaflet valves have larger EOAs than the tilting disc design, especially in the larger sizes, due to the larger opening angles and lack of obstructive struts. The regurgitant fractions range from 8% for 21-mm valves to 13% for the 29-mm sizes. This increase was largely due to an increase in leakage volume as opposed to closing volume. Furthermore, the leakage volumes increased as the mean aortic pressures increased. The tilting disc valves generally have better regurgitant characteristics compared to the bileaflet valve designs, due to lower leakage volumes and to the smaller opening angle of the occluder providing a more rapid closure of the valve. The velocity and shear stress measurements showed that none of the current valve designs are ideal: all designs create areas of stasis and/or regions of low-velocity reverse flow and regions of elevated turbulent shear stresses capable of causing sublethal and/or lethal damage to the formed elements of blood. It is therefore unlikely that these valve designs will eliminate the problems of hemolysis, thrombosis, and thromboembolic complications.

Aortic Valve↗
PubMed1975

Treatment of osteolytic myelomatosis with mithramycin.

The treatment of rapidly progressive skeletal demineralisation in myelomatosis has been studied with the help of metabolic calcium balance in two patients; In one, osteoporosis accelerated during treatment with melphalan and prednisolone, although he remained normocalcaemic throughout, suggesting that osteoporosis was aggravated by corticosteroid therapy. In the other patient, who was initially hypercalcaemic, conventional treatment produced clinical remission before eventual relapse with more hypercalcaemia and skeletal dissolution. Both patients were then treated with mithramycin alone, and, although neither obtained haematological remission, bone pain was relieved, hypercalciuria and hypercalcaemia were abolished, and calcium balances proved that mithramycin was effective in restoring calcium equilibrium. The results indicate that mithramycin may abolish excessive bone resorption in myelomatosis and that severe bone dissolution may occur in the absence of hypercalcaemia. Regular determination of 24-hour urinary calcium excretion as well as of plasma-calcium is important in monitoring process. Mithramycin should be considered in the early treatment not only of hypercalcaemia but also of severe hypercalciuria, if these complications do not rapidly remit during the first course of conventional myeloma therapy, with or without steroids. Finally, these results add to evidence that a humoral factor may be responsible for osteoclast stimulation in myelomatosis.

Aged↗
PubMedDate not supplied

Effect of heart rate on centerline velocities of pulsatile intracardiac jets: an in vitro study with laser Doppler anemometry and pulsed Doppler ultrasound.

This article confirms a recently developed distal jet centerline technique for noninvasively quantifying regurgitant cardiac valve flows. The basic principle that allows flow rate to be calculated is conservation of momentum. As the jet entrains more mass, its centerline velocity decays inversely with distance from the orifice. Under pulsatile flow conditions, it has been shown that this technique remains applicable at peak flow for a normal resting adult heart rate of 60 to 70 beats/min. It is, however, conceivable that at higher heart rates, the same inverse relation between centerline velocity and distance is never fully established, because there is a finite time interval required for the jet to penetrate the receiving chamber. Therefore, the purpose of this study was to determine whether the inverse relationship of centerline velocity to distance develops sufficiently rapidly so that quantitative techniques based on that decay would be applicable over a wide range of heart rates. Two different techniques, an engineering tool, laser Doppler anemometry, and a clinical tool, Doppler ultrasound, were used for measuring jet centerline velocities (averaged over multiple beats). Physiologic pulsatile flows were pumped through two circular orifices, 4 and 6 mm in diameter, at 60 to 150 beats/min; peak orifice velocities ranged from 2 to 5 m/sec. Steady flow experiments were also performed with the same orifice diameters and over the same velocity range. Peak centerline velocities in the fully developed turbulent jet region decayed inversely with distance at all heart rates studied. With laser Doppler anemometry, the proportionality constant of the decay curve was found to be in the range 6.4 +/- 0.5. The pulsed Doppler results provided a jet constant in the range 6.7 +/- 0.3 with the 4-mm orifice diameter, whereas the constant was 6.5 +/- 0.3 with the 6-mm orifice diameter. In steady flow, the proportionality constant was found to be 6.1 +/- 0.2. Therefore, within a wide range of physiologic heart rates, full jet development occurs with sufficient speed so that the expected centerline velocity decay is established (jet empirical constant of 6.3). The conservation of momentum technique for calculating orifice flow rate on the basis of these centerline velocities is thus applicable under physiologic conditions.

Blood Flow Velocity↗