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Biomedical subjects

R B Forbes

Publications and source records attributed to R B Forbes.

At least 19 recordsLinked to original sources
PubMed2004

Methotrexate for multiple sclerosis.

BACKGROUND: Methotrexate is a potent immunosuppressant which in theory could reduce relapse rates and delay disease progression in multiple sclerosis (MS). Subsequently, clinical trials of methotrexate have been conducted in people with MS. OBJECTIVES: To identify and summarise the evidence that methotrexate is beneficial and safe for people with MS. SEARCH STRATEGY: We searched the Cochrane MS Group trials register (searched December 2003), the Cochrane Central Register of Controlled Trails (The Cochrane Library Issue 4, 2003), MEDLINE (Pub Med) (January 1966 to June 2001), EMBASE (January 1988 to June 2001), and reference lists of articles. We also contacted trialists and pharmaceutical companies. SELECTION CRITERIA: Randomised controlled trials of methotrexate for the prevention of relapses and disease progression in MS. DATA COLLECTION AND ANALYSIS: Two reviewers (OG, GM, ) independently selected articles for inclusion, assessed the trials' quality and extracted the data. Authors of one trial were contacted to obtaining missing information. MAIN RESULTS: One trial involving 60 participants with chronic progressive multiple sclerosis was included. The trial showed a non-significant reduction in sustained EDSS progression and number of relapses in favour of methotrexate therapy. There was no difference in time to first relapse and no data on relapse rate. Minor side-effects were reported frequently in both methotrexate (87.1%) and placebo groups (89.7%), but there were no major side-effects. REVIEWERS' CONCLUSIONS: In progressive MS, the single included trial reveals a non-significant trend in reduction of sustained EDSS progression and number of relapses in favour of methotrexate. A trial of methotrexate in relapsing remitting MS showed non-significant trends in favour of methotrexate but was excluded on methodological grounds. Before drawing further conclusions regarding the efficacy of methotrexate in MS, further trials are required.

Humans↗
PubMed2004

Unexpected decline in survival from amyotrophic lateral sclerosis/motor neurone disease.

OBJECTIVES: To describe survival of 1226 Scottish adults with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND). METHODS: Ten year, prospective, population based disease register. Cox time dependent proportional hazards modelling for multivariate survival analyses. RESULTS: Median survival from onset was 25 months (interquartile range 16-34 months). In multivariate models we found an increased hazard with more recently diagnosed cases-that is, there was an unexpected decline in survival over the 10 year period (hazard ratio (HR) 1.06 (95% CI 1.04 to 1.09). Positive effects on survival were demonstrated for longer time from onset to diagnosis (HR 0.38 (95% CI 0.33 to 0.42), assessment by a neurological specialist (HR 0.56 (95% CI 0.40 to 0.77), and treatment with riluzole (HR 0.24 (95% CI 0.14 to 0.42). Poor prognosis was associated with bulbar onset (HR 1.25 (95% CI 1.09 to 1.46) and a mixed lower and upper motor neurone syndrome (HR 1.23 (95% CI 1.01-1.49) and increasing age. CONCLUSIONS: We found an unexpected decline in survival over the 10 year period, despite controlling for potential confounding variables. We would be cautious about over-interpreting these observations and suggest that further research is required to confirm or refute these findings.

Aged↗
PubMed2003

Intravenous immunoglobulins for multiple sclerosis.

BACKGROUND: From animal experiments, there is evidence to suggest that intravenous immunoglobulins can reverse some of the disease process of central nervous system demyelination. Subsequently, clinical trials of intravenous immunoglobulins have been conducted in people with multiple sclerosis (MS). OBJECTIVES: To identify and summarise the evidence that intravenous immunoglobulins are safe and beneficial for people with MS. SEARCH STRATEGY: We searched the Cochrane Multiple Sclerosis Group trials Register( January 2003) The Cochrane Central Register of Controlled Trials (The Cochrane Library issue 4, 2002), MEDLINE (January 1966 to April 2001), EMBASE (January 1988 to April 2001) and reference lists of articles. We also contacted relevant pharmaceutical companies and authors of identified trials. SELECTION CRITERIA: Randomised controlled trials of intravenous immunoglobulins for the secondary prevention of relapses and disease progression in MS. DATA COLLECTION AND ANALYSIS: 913 titles and abstracts were obtained from the literature search, and we eventually identified 10 clinical trials. All reviewers agreed on the final dataset for entry into RevMan 4.1, and summarised the results. Study authors were contacted for additional information but no response was obtained. MAIN RESULTS: Of 913 potential studies, 10 trials were identified with a total of 918 participants, four of which are in progress or awaiting publication. The remaining six trials were suitable for consideration by this review (344 participants). Only two trials met our protocol's inclusion criteria. The four remaining trials were excluded as they did not use outcome measures specified in our review (2 trials, 122 participants), or were of insufficient methodological quality (2 trials, 34 participants). From the two included trials (168 participants) there was a reduction in relapse rate and increased time to first relapse during treatment with intravenous immunoglobulins, but reliable disease progression outcomes were not reported, nor were magnetic resonance imaging (MRI) data available to support clinical information. There may be as many as 574 participants in ongoing or yet to be published trials. REVIEWER'S CONCLUSIONS: There is some evidence to support use of intravenous immunoglobulins as a preventative treatment for relapses in relapsing remitting MS, but further studies should be performed using MRI and disease progression endpoints. It may be possible to draw more robust conclusions when ongoing or recently completed trials make their data available for review. Two rigorously conducted trials with a total of 122 participants did not demonstrate a positive clinical benefit, but were excluded from this review as they employed outcome measures not specified in our protocol. Immunoglobulins were well tolerated with a less than 5% risk of adverse events in participants in included trials.

Humans↗
PubMed2001

Primary isolated brainstem injury producing internuclear ophthalmoplegia.

Abstract Brainstem injuries are classically associated with a grave prognosis. We present a case of a male with primary isolated brainstem injury who had a right internuclear ophthalmoplegia who made a complete recovery. A review of literature suggests that the mortality from such injuries is about 6% and most make a good functional recovery.

Adolescent↗
PubMed2001

Are the El Escorial and Revised El Escorial criteria for ALS reproducible? A study of inter-observer agreement.

INTRODUCTION: For accurate diagnosis, inter-observer agreement of criteria is important. METHODS: Using case records, the reproducibility of the original and revised El Escorial diagnostic criteria for amyotrophic lateral sclerosis were tested in a consecutive series of people referred to the Scottish Motor Neuron Disease Register. RESULTS: Agreement between independent observers was similar (weighted kappa: 0.783, 95% CI 0.656 to 0.911 (original criteria), 0.681, 95% CI 0.485 to 0.878 (revised)). CONCLUSIONS: Serious errors are unlikely, but the revised criteria may be less reproducible as they include more diagnostic categories. Revisions of diagnostic criteria should be tested for reproducibility and validity prior to widespread adoption.

Amyotrophic Lateral Sclerosis↗
PubMed1999

Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis.

OBJECTIVE: To evaluate the cost utility of interferon beta-1b in secondary progressive multiple sclerosis. DESIGN: Population based cost utility model (healthcare perspective). Data on use of health services were obtained from case records and routine morbidity data and utility values from a EuroQol survey. Local and published costs were used. Effectiveness was modelled using data on relative risk reductions from a randomised trial of interferon beta-1b. SETTING: Tayside region, 1993-5. SUBJECTS: 132 ambulatory people with secondary progressive multiple sclerosis. MAIN OUTCOME MEASURES: Cost per quality adjusted life year (QALY) gained. Rate of relapse and proportion becoming wheelchair dependent over three years. RESULTS: The number needed to treat for 30 months to delay time to wheelchair dependence in one person by nine months was 18 (95% confidence interval 5 to 26). For every 18 people treated for 30 months, six relapses would be prevented, gaining 0.397 discounted QALYs. The cost per QALY gained was 1 024 667 pounds sterling (276 466 pounds sterling to 485 499 pound sterling). If treatment was restricted to patients attending neurology services, the number needed to treat was 14 (cost per QALY gained 833 pounds sterling 514 (161 358 pounds sterling to infinity)). The cost per QALY gained was not sensitive to changes in cost which took account of a societal perspective. CONCLUSIONS: The cost per QALY gained from interferon beta is high because of the high drug cost and modest clinical effect. Resources could be used more efficiently elsewhere.

Activities of Daily Living↗
PubMed1999

Estimating the prevalence of multiple sclerosis in the United Kingdom by using capture-recapture methodology.

The geographic distribution of multiple sclerosis is nonrandom, as the disease is more prevalent in temperate than in tropical regions. Surveys conducted between 1970 and 1996 suggest that multiple sclerosis is more prevalent in the northern part of the United Kingdom than in the southern part. This north-south gradient ("the latitudinal gradient") might be a methodological artifact, because high prevalence figures from serial surveys of the northern part of the United Kingdom might have been the result of better ascertainment. By using capture-recapture methods, the authors found that case ascertainment was similar in the northern and southern parts of the United Kingdom. When prevalence figures for multiple sclerosis in the southern United Kingdom were increased to account for the number of unobserved cases, the difference persisted: The prevalence of multiple sclerosis in the northern part of the United Kingdom appeared to be at least 180 cases per 100,000 persons, whereas the maximum prevalence in the southern part of the United Kingdom was less than 160 cases per 100,000 persons. The distribution of multiple sclerosis in the United Kingdom is not uniform and is consistent with the hypothesis that populations with a high prevalence of multiple sclerosis may be genetically predisposed to the disease.

Adult↗
PubMed1999

The prevalence of multiple sclerosis in Tayside, Scotland: do latitudinal gradients really exist?

To determine the prevalence of multiple sclerosis (MS) in the Tayside Health Board Area, Scotland, we carried out a population-based survey using four intersecting sources (Neurology Department records, a survey of general practitioners, Scottish Morbidity Records of discharges from hospitals and visual evoked response requests). A two-source capture-recapture model estimated survey coverage, and direct age-sex standardisation was used to take account of different population structures. Comparisons were made between the prevalence in Scotland and that in the rest of the United Kingdom. A total of 727 (definite and probable) and 880 cases (early, probable and possible) were identified using the criteria of Poser et al. and those of Allison and Millar in a population of 395,600 (1995 mid-year estimate). The prevalence of MS on 1 September 1996 was 184/100,000 (95% confidence interval 171-198) and 222/100,000 (95% confidence interval 210-240), respectively. The two-source capture-recapture model estimated that the survey was between 93% and 99% complete. Age-sex standardisation eliminated certain north-south differences in prevalence when comparisons were made with previous surveys. Diagnostic misclassification may also have influenced reported prevalence statistics. The prevalence is similar to that found in revised figures from the Grampian region in Scotland but significantly higher than recent estimates from England and Wales. Methodological differences may account for most of the reported differences between north and south, although there is still evidence to suggest that MS is more prevalent in northern Great Britain and Northern Ireland than in England and Wales.

Adolescent↗
PubMed1998

Meningeal chondrosarcomas, a review of 31 patients.

We reviewed the literature to study the clinical features, the management and the outcome of meningeal chondrosarcomas. We included 31 patients in this review: 22 were mesenchymal and nine were non-mesenchymal. The mean age was 27 years and 64% arose from the cranial meninges. The treatment was mainly total surgical excision. Adjuvant therapy was given to 36% of patients. Spinal meningeal chondrosarcomas had a better prognosis (81% 1-year survival and 45% 3-year survival). There were no pathognomonic clinical or radiological features. We concluded that the best management of meningeal chondrosarcomas is total surgical excision whenever possible, followed by combined course of radiotherapy and chemotherapy as soon as possible.

Adult↗
PubMed1997

Transfusion management in pediatric and adolescent scoliosis surgery. Efficacy of autologous blood.

STUDY DESIGN: A retrospective review of consecutive pediatric and adolescent patients who required posterior spinal fusion to correct scoliosis. OBJECTIVES: To 1) measure the participation of pediatric patients in predeposit programs for autologous and directed blood donation 2) to assess the success of autologous predonation in preventing allogeneic blood use, 3) to determine whether transfusion indications differed between patients who received allogeneic blood and those who received autologous blood, and 4) to assess factors that predict transfusion requirements during scoliosis surgery. SUMMARY OF BACKGROUND DATA: Authors of recent studies in adults have questioned whether transfusion of autologous blood is a cost-effective therapy when compared with the less-expensive alternative--transfusion of allogeneic blood. In children, the efficacy of autologous blood has not been assessed in a large population of surgical patients. In adults, the frequency of patient participation, the success of autologous donors in avoiding allogeneic transfusion, and the proportion of collected autologous units used during the perioperative period are measures used to establish the efficacy of autologous predonation programs. METHODS: Hospital and clinic records for each patient who underwent posterior spinal fusion from September 1, 1989 through September 1, 1994 were reviewed. Blood bank consultation, autologous donation records, anesthesia records, surgical reports, and hospital records were reviewed. Seventy percent of patients (164 of 243) participated in autologous donation. RESULTS: More than 90% of autologous donors successfully avoided receiving allogeneic blood. Patients with idiopathic scoliosis (n = 168) were more likely to participate in autologous donation (n = 144) and to avoid allogeneic blood (n = 135). Patients with neurologic causes of scoliosis more commonly used allogeneic or directed donation (56 of 75 patients). Nineteen patients with neuromuscular causes of scoliosis participated in autologous donation, but more than one half of this group (10 of 19 patients) required allogeneic blood in addition to autologous units. CONCLUSIONS: Using measures of efficacy similar to those reported in studies of adults, autologous blood was found to be more effective in meeting the transfusion needs of pediatric patients who required posterior spinal fusion than in meeting those needs in adult surgical patients in previous studies.

Adolescent↗
PubMed1995

Anesthesia for magnetic resonance imaging in children: a low incidence of protracted post-procedure vomiting.

STUDY OBJECTIVE: To determine the incidence and severity of vomiting in pediatric patients who have had inhalation anesthesia for magnetic resonance imaging (MRI). DESIGN: A retrospective study of consecutive pediatric patients who had anesthesia for MRI. SETTING: A large university hospital with an integrated clinic facility. PATIENTS: 234 children who required an MRI under general anesthesia over a 30 month period (July 1989 to February 1992). MEASUREMENTS AND MAIN RESULTS: The duration of inhalation anesthesia was 105 +/- 33 minutes. Following anesthesia, the time to oral intake was 92 +/- 69 minutes. Eighteen patients (9%) experienced one or more episodes or emesis. In 14 of the 18 patients, vomiting occurred once and did not delay the intake of oral fluids or the discharge time from clinic when compared with the rest of the patients. Only one patient had frequent vomiting (more than three episodes), and all vomiting resolved spontaneously without anti-emetic therapy in less than eight hours following anesthesia. CONCLUSIONS: Protracted post-procedure vomiting is an infrequent complication of inhalation anesthesia for MRI. Inhalation anesthesia may be a less important cause of postoperative vomiting than factors such as the type of operative procedure, use of opioids, or presence of postoperative pain.

Anesthesia, Inhalation↗
PubMed1995

Cyclical etidronate and calcium carbonate (with citrate) supplementation for osteoporosis unmasking primary hyperparathyroidism.

An 88 year old lady undergoing cyclical etidronate and calcium carbonate (with citrate) therapy for vertebral osteoporosis was found to be symptomatically hypercalcaemic at the end of the first cycle of treatment. She had been previously asymptomatic and normocalcaemic, but was subsequently found to have primary hyperparathyroidism. This condition is most prevalent in postmenopausal females--the same patient group at risk of osteoporosis. Serum calcium should be measured after commencing cyclical etidronate and calcium carbonate. If hypercalcaemia is detected primary hyperparathyroidism should be excluded as an underlying, cause.

Aged↗