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Biomedical subjects

R A Elton

Publications and source records attributed to R A Elton.

At least 19 recordsLinked to original sources
PubMed1995

Transcutaneous oxygen levels in retinopathy of prematurity.

Retinopathy of prematurity (ROP) is a potentially blinding disease of preterm infants. 21 days of computer-recorded transcutaneous oxygen (TcPO2) data were compared in 31 infants with stage 3 or greater ROP and 38 infants with no ROP or stage 1 or 2. In a multiple logistic regression adjusted for significant perinatal factors (birthweight, gestation, and intraventricular haemorrhage), babies with stage 3 or higher ROP showed an increased variability of TcPO2 in week 1 (p < 0.01) and 2 (p = 0.012) but not week 3. Variability of TcPO2 in the first 2 weeks of life is a significant predictor of severe ROP.

Blood Gas Monitoring, Transcutaneous↗
PubMed1995

In-hospital mortality after out-of-hospital cardiac arrest.

In-hospital management of out-of-hospital cardiac arrest is complicated by uncertainty about prognosis and the need to identify markers of adverse outcome in individuals surviving initial resuscitation. We sought to identify factors that predict in-hospital death among patients who initially survive out-of-hospital cardiac arrest. We investigated 346 consecutive cases of out-of-hospital cardiac arrest received by a single centre in Edinburgh, UK (270 cases examined retrospectively, 76 prospectively). Of the retrospective cohort, 246 cases were thought to be of cardiac origin. There were associations between in-hospital mortality and pre-arrest variables, resuscitation variables, and factors measured during admission. Crew-witnessed arrests were associated with low mortality; arrest rhythm (p < 0.001), resuscitation by a health professional (p < 0.05), conscious level on admission (p < 0.001), and requirement for ventilation (p < 0.05) independently predicted in-hospital mortality. A weighted prognostic scoring system based on three of these variables accurately predicted the likelihood of in-hospital death in the prospective test group. Further assessment of conscious level during admission with the Glasgow coma score predicted mortality rates in the study population, but coma did not predict a hopeless prognosis in individual cases unless it persisted for 72 h or more. Accurate prognostic assessment of out-of-hospital cardiac arrest survivors can be made from information available on admission. Of factors that independently predicted outcome, the skill of the resuscitator is most readily modified. This suggests that public training in resuscitation may reduce mortality rates.

Adult↗
PubMed1995

Analysis of prognostic variables in the prediction of mortality, shunt failure, variceal rebleeding and encephalopathy following the transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage.

BACKGROUND/AIMS: The aim of this study was to analyse prognostic variables predicting mortality, shunt insufficiency, variceal rebleeding and encephalopathy following transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage. METHODS: Sixty-eight patients with cirrhosis who successfully underwent transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage were studied. Mean age was 54.8 years (s.e. 1.5); 41 were males and 27 were females. Mean Child score was 8.3 (s.e. 0.3). Cirrhosis was alcohol related in 47. The patients have been followed up for a mean of 10.8 (s.e. 1.1) months. The univariate association between 30 prognostic variables and post-treatment encephalopathy was tested by the Chi-squared or Wilcoxon rank-sum tests and multiple logistic regression was used to test the significance of factors adjusted for one another. Cox's proportional hazard regression was used to test the univariate and multivariate significance of the other three outcomes. RESULTS: Transjugular intrahepatic portosystemic stent-shunt was performed successfully in 89.5% of patients. Twenty-two patients have died and eight have been transplanted. Fourteen patients died within 30 days of transjugular intrahepatic portosystemic stent-shunt and death was predicted independently by hyponatraemia (p < 0.001) and by severe liver disease (Child C, p < 0.001). Eight patients died during follow up and survival in the long term was predicted independently by the presence of encephalopathy (p < 0.001) prior to transjugular intrahepatic portosystemic stent-shunt (p < 0.001). Shunt insufficiency was predicted by an initial portal pressure gradient of greater than 18 mmHg (p < 0.01). None of the variables analysed predicted variceal rebleeding. Encephalopathy following transjugular intrahepatic portosystemic stent-shunt was only predicted indepedently by its presence prior to transjugular intrahepatic portosystemic stent-shunt (p < 0.001). CONCLUSIONS: The results of this study suggest that patients with severe liver disease and hyponatraemia are liable to die early, and the presence of encephalopathy prior to transjugular intrahepatic portosystemic stent-shunt independently determines long-term survival. Patients in these groups should be considered high risk and worked up for orthotopic liver transplantation early. Shunt function in patients with an initial portal pressure gradient of > 18 mmHg requires close supervision. Encephalopathic patients should have smaller shunts and prophylactic measures to prevent worsening encephalopathy.

Esophageal and Gastric Varices↗
PubMed1995

A case for synchronous reduction of testicular androgen, adrenal androgen and prolactin for the treatment of advanced carcinoma of the prostate.

The present study was undertaken mainly to investigate whether prolactin manipulation combined with maximal androgen blockage improves the effectiveness of treatment in advanced prostatic cancer. The efficacy of oral hydrocortisone as an alternative to commercial anti-androgens in reducing the adrenal androgens, and of bromocriptine in reducing the prolactin level were also examined. A consecutive series of 30 patients with untreated and advanced prostatic cancer were entered into a three-arm prospective randomised trial. 10 patients received subcapsular orchiectomy alone (arm 1), another 10 had subcapsular orchiectomy plus flutamide (arm 2), and the remaining 10 had subcapsular orchiectomy plus oral hydrocortisone and bromocriptine (arm 3). Clinical and biochemical parameters, including trans-rectal ultrasound-determined prostatic volumes, hormonal profiles and radionuclide bone scan were evaluated at regular intervals. At 12 months, serum testosterone was reduced by more than 90% in all arms, however, maximum suppression of androstenedione, prolactin, and reduction of prostatic volumes were only observed in arm 3; this was reflected by the significant improvement in clinical response in arm 3 compared with other arms. This study suggests that a combined maximal suppression of androgens and prolactin offers a significant improvement in response over conventional treatments without prolactin suppression in the treatment of advanced prostatic cancer. Importantly, a better clinical outcome in arm 3 was still apparent at the end of 36 months.

Androgen Antagonists↗
PubMed1995

Age-related mortality in patients treated endoscopically for bleeding peptic ulcer.

Before the widespread use of endoscopic therapy, mortality from peptic ulcer hemorrhage was highest in elderly patients, and many deaths in this group were a consequence of postoperative complications. Endoscopic intervention greatly reduces the need for an emergency surgical operation, and consequently increasing age may no longer be a risk factor for death from bleeding ulcer. To examine this hypothesis, the outcome of 326 patients undergoing endoscopic therapy for bleeding peptic ulcer was related to age. One hundred two patients were less than 60 years of age (group I), 116 were 61 to 74 years of age (group II), and 108 were older than 75 years (group III). More group III patients were women (p < .0001) and were receiving nonsteroidal anti-inflammatory drugs (p < .0001). Associated concomitant diseases were significantly more common in group II and group III patients (p < .001). Forty-nine (45%) group III patients bled from gastric ulcers. More of group II patients were receiving anticoagulant drugs (p < .005). A previous history of peptic ulcer was most common in group I (p < .005), and duodenal ulcer was usually the cause of bleeding in this group. The three groups were well matched in terms of endoscopic stigmata (active bleeding and nonbleeding vessel), admission hemoglobin concentration, the presence of shock, and total transfusion requirements. Endoscopic therapy (injection or heater probe) was possible in 95% of all patients. The need for surgical intervention tended to be lowest in group I (11%, 19%, and 18%), whereas hospital mortality (3%, 6%, and 5%) was very similar. In this large group of unselected patients with major peptic ulcer bleeding, age did not significantly influence response to endoscopic therapy or hospital mortality.

Adolescent↗
PubMed1995

The Edinburgh Cardiac Surgery Score survival prediction in the long-stay ICU cardiac surgical patient.

Predictors of outcome in long-stay patients following cardiac surgery have hitherto been ill defined. The aims of this study were to test the Parsonnet pre-operative scoring system and to define a scoring system for inhospital mortality applicable post-operatively to strengthen the clinical decision-making process. Following case note review of 262 consecutive patients who stayed 7 days or more in intensive care, a total of 110 pre-, intra- and post-operative factors were documented. In this long-stay group the Parsonnet score was confirmed to be predictive of 30 day mortality. Univariate analysis identified significant association between mortality in the Intensive Care Unit (ICU) and the following: inotrope days, (defined as number of inotropes times number of days) ventilation, units of platelets (P = < 0.00001), chest reopening, fresh frozen plasma units (P < 0.002), total parenteral nutrition, noradrenaline, Parsonnet score (P = 0.005), dopamine, bypass time, vasodilators, intra-aortic balloon counterpulsation, enteral nutrition and other major surgery (P < 0.05). Stepwise logistic regression on these significant factors was used to produce the Edinburgh Cardiac Surgery Score (ECS) applicable from Day 10 onwards in the intensive care unit: ECS Score = (Inotrope days) +2 (Ventilation) + (Platelets) + (Parsonnet) -3. The ECS score may be a useful predictor of ICU mortality probability for cardiac surgical patients requiring 10 days or more intensive care and is presently undergoing prospective evaluation in our centre.

Adult↗
PubMed1995

Is a telephone helpline of value to the workplace smoker?

This paper reports the findings of the evaluation of a national smokers' helpline which was set up by British Telecom (BT) for its employees. The helpline formed part of a new comprehensive smoking policy for all BT staff. Over 1000 employees, more than 3.0% of all smokers, phoned the helpline during the first three months of its operation. Two-thirds of callers tried to quit smoking after calling the helpline, and a quarter were still successful three months later. One in six callers reduced the number of cigarettes that they smoked on working days. While the helpline and other cessation support services were evaluated positively by callers, it appears that helplines only appeal to a small minority of smokers. However, they do seem to be an effective mechanism for a nationwide company to identify those smokers who want support, and a useful means of centralizing the administration of support services. They are potentially a cost-effective option for larger employers.

Adolescent↗
PubMed1995

Platelet size in stroke patients.

BACKGROUND AND PURPOSE: Large platelets are more reactive, produce more prothrombotic factors, and aggregate more easily. Platelet size can be readily estimated using automated analyzers, although accurate estimation depends on precise methodology. The disparate results from previous studies of mean platelet volume in cerebral ischemia may be explained by varying methodology. We have studied these variables using a precise methodology in an unselected group of stroke patients and compared them with data from age- and sex-matched control subjects. METHODS: We studied 58 stroke patients consecutively admitted to a geriatric medical unit. Platelet variables were measured in the acute (< 48 hours after stroke) and chronic (> 6 months) phases of cerebral ischemia and compared with control variables. Control patients, admitted to the same unit, were of similar age and sex and without evidence of acute vascular events. RESULTS: Mean platelet volume was higher in acute stroke (11.3 compared with 10.1 fL in control subjects; P < .001, Student's t test). In addition, platelet count was reduced in stroke patients (255 x 10(9)/L) compared with control subjects (299 x 10(9)/L; P < .01). Repeated measurements of mean platelet volume and platelet count in available survivors showed no significant change from the acute phase. Platelet changes did not relate to outcome measured at 6 months. CONCLUSIONS: With the use of more precise methodology, these findings show that an increase in mean platelet volume and a reduction in platelet count are features of both the acute and nonacute phases of cerebral ischemia. It is possible that these changes precede the vascular event, and further studies are warranted.

Aged↗
PubMed1995

Percutaneous varicocele embolization in the treatment of infertility.

Clinical and sub-clinical varicoceles are associated with infertility and abnormal sperm parameters. Percutaneous embolization is a minimally invasive, safe, outpatient method of treatment which is cost effective in comparison to surgery. This study is a retrospective review of embolization of the spermatic vein using stainless steel occluding spring coils, performed in 116 males from two infertility clinics. Follow-up results were complete in 87 patients of which 79 (91%) were successful both technically and clinically and all had sperm analysis performed both before and within 2 years after embolization. There was a highly significant increase in motility (mean 35% before, mean 46% after, p < 0.001). Sperm density showed a trend towards improvement, but only p < 0.10, and there was no significant change in semen volume or morphology. The partners of 29 men (33%) became pregnant in a total of 241 years of follow-up.

Adult↗
PubMed1995

Laparoscopy and histology in the diagnosis of chronic liver disease.

We compared laparoscopy with histology in identifying fatty change, fibrosis, the degree of inflammatory activity, cirrhosis and the cause of liver disease. Laparoscopic liver biopsy was performed in 145 consecutive patients. The laparoscopist and the histologist were provided with similar clinical and biochemical information. Both scored the appearances on respective examinations for the degree of fatty change, fibrosis and activity, presence or absence of cirrhosis; and provided a provisional diagnosis. The final diagnosis was determined by clinicopathological conference and clinical follow-up. Laparoscopy was successfully performed in 142 patients (97.9%). Compared with histology, the sensitivity and specificity of laparoscopy for identifying fatty change were 96.4% and 100%, 100% and 95% for fibrosis and 94% and 95% for inflammatory activity, respectively. For cirrhosis, laparoscopy was 100% sensitive and 97.1% specific. Histology missed 10 cases of cirrhosis (6.1%). Histology did, however, provide additional information in 9 patients (6.3%) which contributed to the final diagnosis. Overall, histology is required in addition to laparoscopy in cases where the aetiology is unclear. The sensitivity and specificity in identifying fatty change, fibrosis, activity and cirrhosis are similar for laparoscopy and histology. The combination of information gained on laparoscopy with histology provides the diagnosis in most patients. Laparoscopy may replace the need for liver biopsy in patients in whom the aetiological diagnosis is not in question and the biopsy is being performed to stage the disease. We used it as an integral part of the work-up of a patient with liver disease.

Adolescent↗
PubMed1995

The platelet count as a predictor of variceal hemorrhage in primary biliary cirrhosis.

BACKGROUND: Variceal bleeding is a common, life-threatening complication of primary biliary cirrhosis (PBC) that remains difficult to predict. OBJECTIVE: The aim of this study was to identify whether certain biochemical and hematological parameters may be used as predictors of variceal bleeding in patients with PBC. METHODS: Cox proportional hazard regression analysis was used to test whether various prognostic factors were significantly associated with the time of first bleeding in 63 patients with proven PBC, of whom 11 had subsequent bleeding. RESULTS: Both the first available platelet count and the bilirubin level were of significant value in predicting variceal bleeding, but only the platelet count was an independent predictor of bleeding. In the group of patients who subsequently bled, there was a progressive drop in the platelet count over the follow-up period, with a proportional increase in the risk of bleeding; a platelet count below 200 x 10(9)/L was strongly associated with variceal bleeding (p < 0.001). None of the patients with platelet count above 200 x 10(9)/L bled over a total of 136 patient-years follow-up. In the group who did not bleed, no change in platelet count was identified during follow up. CONCLUSION: We conclude that the platelet count can be used as a predictor of variceal bleeding in PBC.

Aged↗
PubMed1992

Neonatal physiological trend monitoring by computer.

A premature baby born up to four months early is a fragile patient dependent on intensive care. The body systems are physiologically immature and so tolerate stress badly. The tendency of these infants to rapidly deteriorate, has led us to use a cotside computer monitoring system which displays physiological trends. Information from standard neonatal monitors is accessed by individual cotside PC's linked to a central network server and Doctors terminal. Trend graphs can be easily manipulated, displaying from 7 minutes to 3 days of physiological information on a single screen. Pathology may be observed in real time as it occurs. The system has 3 main areas of use, (a) as a real time clinical aid to patient management, e.g. apnoea of the newborn; (b) as a research tool, demonstrating the effects of procedures on physiology; (c) for educating members of staff about how physiological events develop. Data is saved for the whole of each neonates intensive care stay. Assessment of staff and parent attitudes by questionnaire have been favourable.

Humans↗
PubMed1992

Glucose tolerance, plasma insulin, HDL cholesterol and obesity: 12-year follow-up and development of coronary heart disease in Edinburgh men.

The insulin response to a standard oral glucose tolerance test (OGTT) and other anthropometric and biochemical risk factors for coronary heart disease (CHD) were measured in a random sample of 107 Edinburgh men, who were initially studied in 1976 when they were 40 and who were reexamined in 1988-89. Fasting glucose and glucose response to OGTT were higher in 1988-89 than in 1976. In contrast, insulin levels did not differ between the initial and follow-up study either before or after the glucose load. Body mass indices increased, except triceps skinfold. Changing patterns in both fasting and OGTT insulin or glucose levels in individuals were related to changes in bodyweight or in subscapular skinfolds. Modifications in serum total and HDL cholesterol were related to changes in fasting insulin and insulin area, respectively, but not to glucose data. Eleven men developed clinical CHD. Neither glucose nor insulin measures obtained in 1976 differed between those with and without CHD. Weight-height index and abdominal skin-folds were higher in those with CHD. HDL cholesterol was significantly lower (P less than 0.05). Abdominal skin-fold but not body mass index remained significant when adjusted for HDL cholesterol. This small study confirms the importance of central obesity and low HDL cholesterol but failed to identify insulin as a risk factor for CHD in this Scottish population.

Blood Glucose↗
PubMed1992

Factors affecting carriage of Neisseria meningitidis among Greek military recruits.

Greek military recruits (993) were examined for carriage of meningococci during July 1990. Blood, saliva and throat swab specimens were obtained and each recruit answered a questionnaire providing information on age, education (a measure of socioeconomic level), place of residence, smoking habits and recent infections. The overall carriage rate was 25% but differed between the two camps: 79/432 (18%) in Camp A and 168/561 (30%) in Camp B (P less than 0.0005). In Camp B, there were significantly higher proportions of recruits who were non-secretors (P less than 0.0005), and/or heavy smokers (P less than 0.0005). They were also younger (less than 19 years old) (P less than 0.001), and on the whole had fewer years of education (P less than 0.0005). By univariate analysis, carriage was significantly associated with smoking. By multiple logistic regression analysis, carriage was associated with smoking (P less than 0.001), age (P less than 0.01) and the camp in which the recruits were based (P less than 0.01). Among recruits in Camp B, 15/38 (40%) of those with recent viral infections were carriers compared with 30% for the camp in general.

Adolescent↗
PubMed1992

Secretor status and humoral immune responses to Neisseria lactamica and Neisseria meningitidis.

Non-secretors of ABO blood group antigens are over-represented among patients with meningococcal diseases. Lower levels of secretory IgA reported for non-secretors have been suggested to compromise mucosal defences. Total serum and salivary IgG, IgA and IgM and levels of these isotypes specific for Neisseria lactamica and five isolates of meningococci were determined by ELISA for 357 pupils and staff of a secondary school in which an outbreak of meningitis occurred. There were no differences in total or specific levels of serum IgG, IgA or IgM or salivary IgG or IgA of secretors compared with non-secretors. Non-secretors had significantly lower levels of salivary IgM (P = 0.022). A similar pattern was observed for levels of IgM specific for N. lactamica and five meningococcal isolates. The significance of these results is discussed with reference to the role of secretory IgM in protection of mucosal surfaces in infants.

Adolescent↗
PubMed1992

Post-menopausal atrophy in elderly women: is a vaginal smear necessary for diagnosis?

The diagnosis of post-menopausal atrophy should preferably be confirmed before any trial of oestrogen treatment for genito-urinary symptoms. The ideal method, cytological analysis of a vaginal wall smear, is not always feasible in elderly women. Might physical examination alone be sufficient? This study aimed to determine which clinical features might best predict atrophy on the smear. Of 120 consecutive women admitted to an acute geriatric unit (mean age 82 years), satisfactory smears were obtainable from 70 (58%). Sixty per cent of these showed severe atrophy but almost one-fifth showed no atrophic changes. Degree of atrophy correlated with physical thinness (p less than 0.01), low parity (p less than 0.01) and dryness on vaginal examination (p less than 0.001). However, none of the other physical findings traditionally thought to indicate atrophy were found to be associated, nor were age or medication. In contrast, severe atrophy was present in only one of nine women with breast cancer (p less than 0.01). This merits further study.

Aged↗